先天性心脏病膜周部室间隔缺损自愈性闭合情况观察

Observation of spontaneous closure of perimembranous ventricular septal defect in congenital heart disease

目的:观察先天性心脏病膜周部室间隔缺损(P-VSD)的自愈性闭合(SC)情况,探讨P-VSD的治疗时机。方法:选取经超声心动图确诊为单纯P-VSD的患儿112例(平均年龄4.7 d),根据有无膜部瘤形成分为膜部瘤形成组(n=59)和无膜部瘤组(n=53)。所有患儿在入选、出生1个月、出生6个月时行超声心动图检查,之后每半年检查1次,随访至6周岁,观察6年内P-VSD的SC率和SC时间。结果:P-VSD患儿6年内发生SC者共64例,其中≤3岁者52例,占≤3岁患儿的46.43%,>3岁者12例,占>3岁患儿的25.00%,3岁以前发生SC的情况较多。所有发生SC的患儿缺损大小平均为(3.9±1.5)mm,SC率为57.14%,SC时间为(2.3±1.5)岁,其中膜部瘤形成组49例,缺损大小平均为(4.0±1.5)mm,SC率83.05%,SC时间为(2.4±1.5)岁;无膜部瘤组15例,缺损大小为(3.5±1.2)mm,SC率28.30%,SC时间为(2.0±1.4)岁。膜部瘤形成组SC率显著高于无膜部瘤组(P<0.05)。26例P-VSD患儿在随访期间接受了手术闭合治疗,其中膜部瘤形成组7例,无膜部瘤组19例,接受手术治疗的患儿缺损明显大于发生SC的患儿[(6.2±1.0)mm对(3.9±1.5)mm,P<0.05]。结论:缺损较小的P-VSD患儿出生后6年内的SC率>50%,有膜部瘤形成的P-VSD患儿较易发生SC;缺损较大的P-VSD患儿SC率较低,建议手术治疗。

Objective:To observe the spontaneous closure(SC)of perimembranous ventricular septal defect(P-VSD)in patients with congenital heart disease and to investigate the treatment timing of P-VSD.Methods:A total of 112 infants with average age 4.7 days who were diagnosed as P-VSD by fetal echocardiography were included.They were divided into the membranous aneurysm group(n=59)and the non-membranous aneurysm group(n=53).All the infants were examined by echocardiography at the time of enrollment,1 month,6 months and followed up every 6 months hereafter until 6 years old to observe the incidence and occurrence time of SC within 6 years.Results:SC occurred in 64 patients with P-VSD within 6 years.Among them 52 cases were 3 years old or less,accounting for 46.43%of the infants aged 3 years or less;and in 25%of the infants older than 3 years(12 cases)SC was observed.Defect size was(3.9±1.5)mm in the infants wih SC.The incidence of SC was 57.14%,and the occurrence time of SC was(2.3±1.5)years old.SC occurred in 49 infants of the membranous aneurysm group,with a defect size of(4.0±1.5)mm at the age of(2.4±1.5)years old.While there were 15 cases occurred SC in the non-membranous aneurysm group,with a defect size of(3.5±1.2)mm at the age of(2.0±1.4)years old.The incidence of SC in the membranous aneurysm group was higher than the non-membranous group(83.05%vs.28.30%,P<0.05).Twenty-six infants,including 7 cases of membranous aneurysm group and 19 cases of non-membranous group,underwent surgical procedures during follow-up period,whose defect size was larger than the one of SC cases[(6.2±1.0)mm vs.(3.9±1.5)mm,P<0.05].Conclusions:The incidence of SC is above 50%within 6 years after birth in P-VSD patients with small defect size.SC is easier to occur in patients with membranous aneurysm.The incidence of SC is low in those with large defect size,so the surgical treatment is recommended.