经胸微创封堵治疗膜周部室间隔缺损效果观察

Clinical observation of minimally invasive transthoracic device closure on perimembranous ventricular septal defects

目的探讨经胸微创封堵膜周部室间隔缺损（pmVSD）的临床效果。方法21例pmVSD患儿术前行经胸超声心动图（TTE）筛选，术中在经食管超声心动图（TEE）引导下行经胸微创封堵术并评估其封堵效果，术后经TTE随访其治疗效果及并发症发生情况。结果全组患儿封堵成功率为95.2%（20/21），平均手术时间（32.4±28.6）min，术后机械通气时间（3.1±2.3）h，平均住院天数（7.2±3.5）d，无死亡病例。1例患儿术中中转开胸行传统外科体外循环下修补手术。术后随访3～12个月，未见并发症发生，无失访情况。结论经胸微创封堵pmVSD简单安全，无需体外循环，创伤小、恢复快，并发症少，值得临床推广应用。

Objective To investigate the clinical effect of minimally invasive transthoracic device closure on perimembranous ventricular septal defects （pmVSD）. Methods Twenty-one patients with pm- VSD were screened by preoperative transthoracic echocardiography （TFE） , minimally invasive transthoracic device closure guided by transesophageal echocardiography （TEE） was performed and the effect of occlusion was evaluated. Treatment effect and complications were followed up by TrE. Results The success rate was 95.2% （20/21）, the average operation time was （32. 4 ±28.6） min, the mechanical ventilation time was （3. 1 ±2. 3 ） h, and the average hospital stay was （7.2 ±3. 5 ）d. One patient was converted to traditional surgical repair under cardiopulmonary bypass （CPB）. All patients were followed up for 3 - 12 months, and no complications occurred, with no patient lost to follow-up. Conclusions The minimally invasive transthoraeic device closure on pmVSD is simple and safe, with no CPB, less trauma, faster recovery and fewer complications, which is worth popularizing.