10公斤以下婴幼儿经胸室间隔缺损封堵术

Transthoracic device closure of ventricular septal defect for infants weighting less than 10 kilograms

目的总结43例10k以下婴幼儿经胸室间隔缺损（VSD）封堵术的经验。方法食管超声引导下，经胸骨下段小切口1．5cm，切开皮肤、胸骨下段及心包，在右心室表面定点，穿刺置入导丝，经VSD送入输送鞘及对称型封堵器封堵VSD。结果本组无死亡，无Ⅲ度传导阻滞，手术时间[（75．5±14．1）min比（136．0±31．4）min]、术后呼吸机辅助时间[（270．1±88．9）min比（773．8±515．4）min]、术后引流量[（61．5±19．7）ml比（110．6±36．0）ml]、术后住院时间[（9．2±2．2）d比（10．9±3．0）d]及输血率低于同期体外循环心内直视修补手术组，差异均有统计学意义（P〈0．05）。结论经胸小切口封堵术治疗10kg以下膜周部室间隔缺损婴幼儿，能减少体外循环带来的风险，创伤小、出血少、恢复快、切口小而美观。

Objective To summarize the clinical experience of transthoracic closure of ventricular septal defect （VSD） in infants and young children weighting less than 10 kg. Methods Following the guidance of transesophageal echocardiography, a small inferior median incision （1.5 cm） was made in the sternum. Then the pericardium was opened and suspended to expose the free wall of right ventricular. A puncture site on the free wall of right ventricular was determined, through which a floppy guidewire was inserted. The delivery sheaths and symmetric VSD device were introduced over the guidewire into the right ventricular cavity. Results The transthoracic device closure of VSD was employed successfully in all the patients, without causing any death or complete atri- oventricular block. Moreover, the transthoracic device closure of VSD showed advantages over the open heart septal defect repair with cardiopulmonary bypass, and significant differences （P〈0.05） exist in terms of operation time [ （ 75.5 ± 14.1 ）min vs （ 136.0±31.4 ）min ], postoperative mechanical ventilation time [ （270.1±88.9 ） min vs （ 773.8 ± 515.4）mini, operation drainage, follow-up period of hospitalization [ （9.2±2.2）d vs （10.9±3.0）d], and transfu- sion volume [（61.5±19.7）ml vs （110.6＋36.0）ml]. Conclusion Using domestically made device under transthoracic echocardiographic guidance, the transthoracic device closure of VSD with an inferior sternotomy is a safe, feasible, and simple treatment, particularly for infants and young children weighting less than 10 kg.