膜周部室间隔缺损合并三尖瓣中、重度反流行介入治疗的疗效分析

Effect Analysis of Interventional Therapy for Perimembranous Ventricular Septal Defect With Moderate or Severe Tricuspid Regurgitation

目的:探讨膜周部室间隔缺损(VSD)合并三尖瓣中、重度反流行介入治疗的可行性,并评价其疗效。方法:分析2016-01至2017-12我院膜周部VSD合并三尖瓣中、重度反流44例患者,通过应用超声心动图,观察VSD形态、三尖瓣反流程度及原因,评估VSD介入治疗效果及三尖瓣反流在介入术前、术后的变化。结果:43例患者介入治疗成功。与术前相比,44例患者术后即刻三尖瓣反流长度[(0.60±0.19)cm vs.(2.72±0.21)cm]、三尖瓣反流面积[(0.55±0.19)cm2 vs.(2.61±0.23)cm2]、三尖瓣反流容积[(0.74±0.26)ml vs.(2.51±0.26)ml]、三尖瓣反流速度[(1.94±0.40)m/s vs.(2.88±0.42)m/s]、三尖瓣反流压差[(16.18±7.92)mmHg vs.(33.10±8.15)mmHg(1 mmHg=0.133 kPa)]明显改善,差异均有统计学意义(P均<0.05),术后3天内、术后1个月、术后3个月、术后6个月和术后1年三尖瓣反流均不同程度减轻,与术前比较差异均有统计学意义。1例介入术后复查超声心动图可见封堵器与三尖瓣腱索缠绕致三尖瓣重度反流行外科手术。结论:经严格筛选适应证的膜周部VSD合并三尖瓣中、重度反流可行介入治疗,且安全有效。

Objectives:To explore the feasibility of perimembranous ventricular septal defect(VSD)with moderate or severe tricuspid regurgitation and evaluate its curative effect.Methods:We analyzed 44 cases of perimembranous VSD with moderate or tricuspid regurgitation in our hospital from January 2016 to December 2017.We used echocardiography to observe the Morphology of VSD,the degree and cause of tricuspid regurgitation,to evaluate the effect of VSD intervention and the changes of tricuspid regurgitation before and after interventional therapy.Results:43 patients were successful in interventional.The length of tricuspid regurgitation[(0.60±0.19)cm vs.(2.72±0.21)cm],the area of tricuspid regurgitation[(0.55±0.19)cm2 vs.(2.61±0.23)cm2],the volume of tricuspid regurgitation[(0.74±0.26)ml vs.(2.51±0.26)ml],the velocity of tricuspid regurgitation[(1.94±0.40)m/s vs.(2.88±0.42)m/s]and the pressure difference of tricuspid regurgitation[(16.18±7.92)mmHg vs.(33.10±8.15)mmHg]were significantly improved after the operation.The difference was statistically significant,all P<0.05.Tricuspid regurgitation was alleviated in different degrees at 3 days,1 month,3 months,6 months and 1 year after operation,and the differences were statistically significant.One patient had severe tricuspid regurgitation because of occluder intertwined with tendinous cord of tricuspid valve on echocardiogram after intervention,and then had surgery.Conclusions:Interventional therapy is feasible for perimembranous ventricular septal defect with moderate or severe tricuspid regurgitation with strict screening of indications,and it is safe and effective.