经皮导管介入封堵治疗膜周部室间隔缺损合并主动脉瓣脱垂的疗效及预后

Transcatheter device closure for perimembranous ventricular septal defects with aortic valve prolapse:Effect and prognosis

目的分析经皮导管介入封堵膜周部室间隔缺损合并主动脉瓣脱垂(aortic valve prolapse,AVP)的疗效及预后。方法回顾2011年1月至2017年1月上海交通大学医学院附属上海儿童医学中心收治的1108例经皮介入治疗膜周部室间隔缺损患儿的临床资料,主要包括手术前后超声心动图、术中造影、封堵器型号及社会人口(年龄、体重、性别)等资料。组间比较计量资料采用独立样本t检验、非参数Mann-Whitney U检验;配对设计计量资料不符合正态分布采用非参数Wilcoxon符号秩检验。计数资料采用Fisher确切概率法;成组设计R×C表格采用MonteCarlo近似确切概率法。多元Logistic回归分析术前合并AVP患儿术后主动脉瓣反流(aortic regulation,AR)出现或加重的危险因素。结果55例术前合并AVP患儿中8例(14.5%)发生术后AR出现或加重。1053例术前不合并AVP的患儿中10例(0.9%)发生术后AR出现或加重,但AR加重情况多发生在术后远期(>1年),且无一例中度以上的AR出现。合并AVP患儿介入手术前后左心室射血分数、左室短轴缩短率及AR加重程度均无统计学意义。结论在选择合适封堵器类型及大小、操作规范并具有相当相关操作经验的儿童心血管中心,经皮导管介入封堵合并AVP的膜周部室间隔缺损可成为外科手术的有效替代方案。

Objective To evaluate the the effect and prognosis of transcatheter device closure for perimembranous ventricular septal defects(PmVSDs)with aortic valve prolapse(AVP).Methods The clinical data of 1108 patients who underwent percutaneous closure from January 2011 to January 2017 were collected to conduct this retrospective study,mainly including transthoracic echocardiography,digital subtraction angiography data,occluder type and sociodemographic information(age,weight and gender).T-test and Mann-Whitney U test were used to compare group measurement data.Wilcoxon signed rank test was used for the nonnormal distribution of paired design data.Fisher exact test was used for the four fold table.Monte Carlo approximation exact probability method was used for the R×C table. Multiple Logistic-regression analysis was used to estimate the risk factors of AR.Results Compared with 10(0.9%)of 1053 patients without AVP,8(14.5%)of the 55 children with preoperative AVP presented aggravated postoperative aortic regulation(AR)and AR usually occurred in the long-term follow-up(>1 year).None of the AR progressed to moderate or severe.There were no significant changes in left ventricular ejection fraction,left ventricular shortening rate or AR before and after interventional operation in PmVSDs with AVP.Conclusion Percutaneous closure for ventricular septal defect combined with AVP is an effective alternative to surgery when using appropriate occluders,meeting related standards and operated in an experienced cardiovascular center.