食道超声下单纯经股静脉封堵膜周型室间隔缺损技术的临床应用

Application of perimembranous ventricular septal defects closure solely by femoral vein approach under transesophageal echocardiography guidance

目的:探讨食道超声引导下行单纯经股静脉路径封堵膜周型室间隔缺损的可行性及安全性。方法:选择2014年1月1日至2016年5月31日在中南大学湘雅二医院就诊的膜周型室间隔缺损患者26例,年龄3.2~6.0(4.3±0.7)岁,体重15.0~19.5(16.7±1.4)kg,直径3.5~4.8(4.1±0.3)mm。患者均在食道超声引导下行单纯经股静脉路径封堵膜周型室间隔缺损,封堵后以食道超声和经胸超声检查评价治疗效果。患者术后第1,3,6,12个月在门诊复查随访。结果:20例患者在食道超声引导下成功完成经股静脉膜周型室间隔缺损封堵术,成功率76.9%。2例因建立轨道失败,4例因输送鞘未能沿导丝通过室间隔缺损,均改经胸小切口,封堵成功。20例患者全部使用等边型室间隔缺损封堵器,封堵器直径为6.0~7.0(6.2±0.4)mm,手术操作时间为12.0~64.0(26.8±6.3)min,ICU滞留时间1.8~2.4(2.1±0.3)h,住院时间为4.0~5.0(4.4±0.5)d。术后即刻微量残余分流3例,不完全右束支传导阻滞3例。所有患者均痊愈出院,且无外周血管损伤、三尖瓣返流、心包填塞及肺部感染等并发症。患者术后均定期随访,随访第1个月时3例微量残余分流患者微量残余分流消失,3例不完全右束支传导阻滞患者恢复正常心律。所有患者未出现封堵器脱落、残余分流、心包积液、心律失常(房室传导阻滞)和主动脉瓣及三尖瓣返流等并发症。结论:食道超声引导下行单纯经股静脉封堵膜周型室间隔缺损是可行的且安全有效的介入技术。

Objective To investigate the feasibility and safety of perimembranous ventricular septal defects （PmVSD） closure solely by femoral vein approach under transesophageal echocardiography （TEE） guidance. Methods： From January 1, 2014 to May 31, 201G 26 patients with PmVSD in Second Xiangya Hospital were selected, with age at 3.2-6.0 （4.3±0.7） years old and body weight at 15.0-19.5 （16.7± 1.4） kg. The diameter of VSD was 3.5-4.8 （4.1±0.3） mm. All patients were treated by percutaneous PmVSD closure solely by femoral vein approach under TEE guidance. The effect of the procedure was evaluated by TEE and transthoracic echocardiography （TTE）. The clinical follow-up study was conducted by TI＇E at 1, 3, 6 and 12 month （s） after the procedure. Results： Twenty cases were successfully treated with percutaneous PmVSD closure solely by femoral vein approach under TEE guidance, and the success rate was 76.9%. Six patients were converted to perventricular closure under TEE guidance because the guide wire in two cases or catheter in other cases could not pass through PmVSD. Xhe diameter of symmetrical VSD occluder was 6.0-7.0 （6.2±0.4） ram. The procedural time was 12.0-64.0 （26.8±6.3） rain. The residence time at ICU was 1.8-2.4 （26.8±6.3） h. The in-hospital time was 4.0-5.0 （4.4±0.5） d. There were 3 patients with immediate post-operative trivial residual shunt and incomplete right bundle branch block （IRBBB）. All patients survived with no peripheral vascular injury or complications such as tricuspid regurgitation, pericardial tamponade and pulmonary infection. The residual shunt disappeared in 3 patients and IRBBB became normal rhythm in 3 patients at 1 month follow-up time point. No patients suffered from occluder malposition, residual shunt, pericardial effusion, arrhythmia （atrio-ventricular block）, aortic valve regurgitation and tricuspid regurgitation. Conclusion： TEE-guided percutaneous PmVSD closureby femoral vein approach is safe and effective.