室间隔缺损封堵器治疗婴幼儿粗大动脉导管未闭的临床观察

Clinical observation of ventricular septal defect occluder in infants and young children with large patent ductus arteriosus

目的:探讨应用室间隔缺损(ventricular septal defect,VSD)封堵器治疗婴幼儿粗大动脉导管未闭(patent ductus arteriosus,PDA)的临床疗效及安全性。方法:收集2017-07~2018-09我院儿科应用VSD封堵器进行介入封堵治疗的10例粗大PDA患儿的病例资料,分析其术中资料、封堵前后肺动脉及主动脉压力、超声心动图及术后随访情况。结果:本组10例患儿均采用膜部VSD封堵器,手术成功率100%。术后即刻主动脉弓降部造影显示,1 例可见极少量残余分流,15 min 后重复造影见分流消失。10例患儿封堵术后肺动脉收缩压由术前的(50.8± 9.7)mmHg 降至术后24 h的(24.0±11.3)mmHg、1个月的(20.0±12.3)mmHg、3个月的( 18.0±9.5 )mmHg、 6个月的(18.0±9.3)mmHg,差异有统计学意义( P <0.05)。封堵术后 24 h ,左心室舒张末期内径较术前减少,左心室射血分数升高,差异均有统计学意义(均 P < 0.05 )。 10例患儿封堵术后随访6个月均无明显并发症发生。结论:对于粗大PDA婴幼儿,采用VSD封堵器进行封堵介入治疗不失为一种有效的微创治疗方法,疗效确切,安全性好,可进一步临床推广应用。

Objective:To investigate the safety and clinical efficacy of ventricular septal defect(VSD)occluder in the treatment of patent ductus arteriosus(PDA).Methods:The data of 10 children with large PDA who were treated with VSD in our hospital′s pediatrics from 2017-07 to 2018-09 were collected.The intraoperative data,pulmonary and aortic pressure,echocardiography and postoperative follow-up were analyzed.Results:In this group,10 patients were treated with VSD occluder,The surgical success rate was 100%,and the membrane VSD occluder was applied.Aortic angiography showed that 1 patient had small residual shunt,which disappeared after 15 minutes.The systolic pulmonary pressure in the patients 24 hours after operation was(24.0±11.3)mmHg,1 month after operation was(20.0±12.3)mmHg,3 months after operation was(18.0±9.5)mmHg and 6 months after operation was(18.0±9.3)mmHg,which were lower than that before operation(50.8±9.7)mmHg(P<0.05).Left ventricular end-diastolic dimension decreased significantly 24 hours after the procedure,and which showed a decreasing tendency during the follow-up(P<0.05).No adverse complications occurred during1,3 and 6 months of follow-up.Conclusion:For infants and young children with large PDA,using VSD blocking device for blocking interventional treatment is an effective minimally invasive treatment,the curative effect is accurate,the safety is good,can further promote clinical application.