经导管封堵主动脉窦瘤破裂的安全性和有效性

Safety and efficacy of transcatheter closure of ruptured sinus of Valsalva aneurysm

目的探讨经导管封堵主动脉窦瘤破裂的安全性和有效性。方法采用回顾性研究方法，入选2006年1月至2017年3月在沈阳军区总医院行经导管封堵治疗的RSVA患者33例。术前均通过超声心动图确诊主动脉窦瘤破裂。术中根据主动脉造影情况选择不同类型的封堵器，对破裂的主动脉窦瘤实施封堵，并在术后进行随访。结果患者年龄（37.6±12.1）岁，男性占78.8%（26例）。主动脉右冠窦瘤破裂25例，其中破入右心房13例，破入右心室12例；其余8例（占24.2%）患者均为主动脉无冠窦破入右心房。术中主动脉造影测量的主动脉窦瘤破裂口直径为（6.4±1.7）mm，肺循环血流量与体循环血流量比值为2.2±0.5，肺动脉平均压为24.0（21.2，33.7）mmHg（1 mmHg=0.133 kPa）。除1例患者在封堵后出现严重主动脉瓣反流转外科行手术治疗外，其余32例主动脉窦瘤破裂患者均完成封堵，手术成功率为97.0%。术中应用细腰型室间隔缺损封堵器20例，应用动脉导管未闭封堵器12例。成功封堵的患者术后随访73.5（28.3，89.5）个月，随访期间均未出现感染性心内膜炎、残余分流、血栓形成、封堵器移位、严重主动脉瓣反流、严重心律失常和死亡等严重并发症。超声心动图显示，末次随访时患者左心房内径[（37.4±6.5）mm比（41.5±5.3）mm，P〈0.01]、右心房内径[（42.4±3.0）mm比（48.5±6.0）mm，P〈0.01]、右心室内径[（22.2±3.8）mm比（27.7±7.2）mm，P〈0.01]和左心室舒张末期内径[（51.3±4.9）mm比（55.0±4.3）mm，P〈0.01]均小于术前。结论经导管封堵主动脉窦瘤破裂安全、有效，长期预后良好。

ObjectiveTo investigate the safety and efficacy of transcatheter closure of ruptured sinus of Valsava aneurysm（RSVA）.MethodsA total of 33 RSVA patients underwent transcatheter closure from January 2006 to March 2017 in our hospital were included in this retrospective study. The RSVA was diagnosed by echocardiography.Different type of occluders were applied for transcatheter closure based on the aortography results. All the patients were followed up after the procedure.ResultsThe patients were （37.6±12.1） years old,and the male patients accounted for 78.8%（26 cases）.RSVA from right coronary sinus was found in 25 patients,and draining chamber was right atrium in 13 cases, right ventricle in 12 cases. RSVA from noncoronary sinus was diagnosed in 8 patients,and the draining chamber was right atrium. Aortography defined the narrowest diameter at the rupture site was （6.4±1.7）mm. The ratio of Qp/Qs was 2.2±0.5,and the mean pressure of pulmonary artery was 24.0（21.2,33.7）mmHg（1 mmHg=0.133 kPa）. One patient developed serious occluder related aortic regurgitation and underwent surgery, transcatheter closure was successfully performed in 32 patients. The success rate of transcatheter closure was 97.0%. Two types of device were used in the study including small-waist double-disk ventricular septal defect（VSD） occluders in 20 cases and patent ductus arteriosus（PDA） occluders in 12 cases. During a median follow-up of 73.5（28.3,89.5） months, there were no infective endocarditis, residual shunt, thrombosis, device displacement,serious aortic regurgitation, serious arrhythmia or death.At the last follow-up, the left atrial diameter（（37.4±6.5） mm vs. （41.5±5.3）mm,P〈0.01）,right atrial diameter（（42.4±3.0） mm vs. （48.5±6.0）mm,P〈0.01）, right ventricular diameter（（22.2±3.8） mm vs. （27.7±7.2）mm,P〈0.01） and left ventricular end-diastolic diameter（（51.3±4.9） mm vs.（55.0±4.3）mm,P〈0.01）measured by echocardiography were all smaller than pre-procedural level.ConclusionTranscatheter closure of RVSA is a safe and effective strategy and associated with a good long-term outcome.