室间隔缺损介入封堵术后并发症的外科治疗

Surgical Treatment of Complications Post Ventricular Septal Defect Occlusion

目的:总结分析室间隔缺损介入封堵术后并发症的发生情况及外科治疗的效果。方法:选择2016年5月至2019年12月因室间隔缺损介入封堵术后并发症就诊于我院并行外科手术治疗的患者14例,分析室间隔缺损介入封堵术后并发症的发生情况、手术方法的选择、手术结果及随访结果。结果:患者室间隔缺损介入封堵术后并发症的发生包括:瓣膜损伤9例(三尖瓣、主动脉瓣损伤分别有5例和6例,其中三尖瓣和主动脉瓣同时损伤2例),左心室流出道梗阻1例,心律失常6例(三度房室阻滞2例、完全性左束支阻滞4例),溶血1例。所有患者均于体外循环下行室间隔缺损封堵器取出术和室间隔缺损修补术;另外,5例患者行主动脉瓣成形术,1例行主动脉瓣置换术,9例行三尖瓣成形术,2例植入永久起搏器。术后重症监护室住院时间为19.00(13.00,46.75)h,呼吸机使用时间为6.00(3.00,9.25) h,总住院时间为7.00(6.00,9.50)d。术后中位随访18.00(7.75,38.00)个月,所有患者室间隔缺损无残余分流,无瓣膜功能不良,植入起搏器的患者起搏器功能良好。结论:室间隔缺损封堵术后需外科手术治疗的并发症较多样,应以预防为主,一旦出现需早期外科干预;外科干预效果良好。

Objectives:To analyze the results of surgical treatment for complications after transcatheter closure of ventricular septal defect(VSD).Methods:From May 2016 to December 2019,14 patients with complications after transcatheter closure of VSD received surgical treatment in our hospital.The complications after transcatheter closure of VSD,selection of surgical approaches,operation results and follow-up results were analyzed.Results:Complications post transcatheter VSD closure included:valve injury(n=9,5 tricuspid valve impairment,6 aortic valve impairment and 2 combined tricuspid and aortic valve impairments),left ventricular outflow tract obstruction(n=1),arrhythmia(n=6,2 III°atrioventricular block and 4 complete left bundle branch block)and hemolysis(n=1).All surgeries were performed under cardiopulmonary bypass.Occluder was removed from all the 14 patients and all patients received surgical VSD repair operations.5 patients underwent additional aortic valvuloplasty surgeries,1 patient underwent aortic valve replacement,9 patients underwent tricuspid valvuloplasty surgeries,and permanent pacemaker implantation was performed in 2 patients.Postoperative intensive care unit time was 19.00(13.00,46.75)hours;mechanical ventilation time was 6.00(3.00,9.25)hours.The length of hospital stay was 7.00(6.00,9.50)days after operation.The median follow-up time was 18.00(7.75,38.00)months.No residual VSD was detected.All repaired valves and implanted permanent pacemakers were at good working conditions.Conclusions:The complications that need surgical treatment after transcatheter VSD occlusion are multiple.Early surgical intervention is essential to treat these complications and the efficacy of surgical treatments is satisfactory in this cohort.