儿童经导管介入封堵膜周部室间隔缺损术后三尖瓣反流的预后及影响因素

Prognosis and risk factors of tricuspid regurgitation after transcatheter closure of perimembranous ventricular septal defects in children

目的探讨儿童经皮导管介入封堵膜周部室间隔缺损术后三尖瓣反流的发生率、预后及反流发生或加重的相关危险因素。方法回顾性分析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,分析术后新发三尖瓣反流及反流加重的预后和危险因素。结果24例术后新发三尖瓣轻度以上反流,发生率为2.1%;5例术前合并轻度以上三尖瓣反流的患儿中4例反流较术前减轻;随访过程中患儿均未发生重度需要手术干预的三尖瓣反流。单因素分析发现介入手术时间、残余分流是介入术后新发轻度以上三尖瓣反流的危险因素(均P<0.05)。二元回归分析发现封堵器大小(OR=1.48,95%CI:1.13~1.9)、残余分流(OR=6.53,95%CI:1.69~25.30)是新发三尖瓣反流的危险因素(均P<0.05)。结论膜周部室间隔缺损介入封堵后有一定的三尖瓣反流发生率,但一般不会出现需干预的后果。手术时间越长、封堵器型号越大、残余分流的存在是导致术中或术后新发三尖瓣反流的危险因素。

Objective To investigate the incidence and prognosis of tricuspid regurgitation after transcatheter closure of perimembranous ventricular septal defects in pediatric patients as well as the risk factors of regurgitation occurrence or aggravation.Methods Clinical data of 1108 patients who underwent percutaneous closure in Shanghai Children′s Medical Center,School of Medicine,Shanghai Jiaotong University from January 2011 to January 2017 was analyzed retrospectively,and the prognosis and risk factors of postoperative tricuspid regurgitation and aggravation were also analyzed.Results Mild tricuspid regurgitation occurred in 24 cases after surgery with the incidence of 2.1%.Among 5 cases with mild or above preoperative tricuspid regurgitation,the regurgitation was alleviated after surgery in 4 cases.No severe tricuspid regurgitation requiring surgical intervention occurred in any patient during follow-up.Univariate analysis showed that intervention time(P<0.05)and residual shunt(P<0.05)were risk factors for mild or above tricuspid regurgitation after intervention.Binary regression analysis indicated that the size of the occluder(mm)(OR=1.48,95%CI:1.13-1.90)and residual shunt(OR=6.53,95%CI:1.69-25.30)were risk factors for tricuspid regurgitation after intervention(all P<0.05).Conclusions There is a certain incidence of tricuspid regurgitation after transcatheter closure of perimembranous ventricular septal defects,but most tricuspid regurgitation do not need surgical intervention.The intervention time,size of occluder and residual shunt are risk factors of intraoperatively or postoperatively tricuspid regurgitation.