单纯食管超声引导下右腋下小切口经右心室途径室间隔缺损封堵术447例效果观察

Clinical effect of 447 cases of transesophageal echocardiography-guided occlusion of ventricular septal defect via right subaxillary small incision

目的探讨单纯食管超声引导下右腋下小切口经右心室途径室间隔缺损封堵术的临床效果。方法抽取2017年2月至2019年7月于郑州大学附属儿童医院门诊确诊的单纯室间隔缺损患儿447例,均行单纯食管超声引导下右腋下小切口经右心室途径室间隔缺损封堵术,总结分析其临床资料。统计其手术效果及术后随访结果。结果447例患儿封堵成功444例(99.33%),失败3例(0.67%)。封堵成功者术后食管超声监测未见二尖瓣、三尖瓣反流较术前明显增加;未见明显主动脉瓣新增反流,存在轻微残余分流12例(2.68%),均<2 mm。术后12 h超声发现封堵器移位1例。随访1年,所有患儿无房室传导阻滞、新发主动脉瓣关闭不全、封堵器脱落、溶血和栓塞等并发症;术后存在轻微残余分流12例中已闭合9例(2.01%),仍有<2 mm残余分流3例(0.67%)。结论单纯食管超声引导下右腋下小切口经右心室途径室间隔缺损封堵术成功率高,并发症少。

Objective To investigate the clinical effect of transesophageal echocardiography-guided occlusion of ventricular septal defect via right subaxillary small incision.Methods A total of 447 patients with ventricular septal defect in Children’s Hospital of Zhengzhou University from February 2017 to July 2019 were enrolled,and they received transesophageal echocardiography-guided occlusion of ventricular septal defect via right subaxillary small incision,the clinical data were summarized and analyzed.The surgical results and postoperative follow-up results were counted.Results Of the 447 cases,444 cases(99.33%)had successful operation and 3 cases(0.67%)failed.The esophageal ultrasound was monitored immediately after successful closure,and there was no significant increase in mitral and tricuspid regurgitation compared with that before operation;there was no new regurgitation in aortic valve,and 12 cases(2.68%)had slight residual shunt,which were all less than 2 mm.Ultrasound showed that 1 case had occluder displacement at 12 hours after operation.After 1-year follow-up,all children had no complications such as atrioventricular block,new aortic insufficiency,occlusion-loss,hemolysis or embolism;ultrasound was monitore.Of the 12 cases of slight residual shunt after operation,9 cases(2.01%)were closed,and 3 cases(0.67%)still had residual shunt less than 2 mm.Conclusions Transesophageal echocardiography-guided occlusion of ventricular septal defect via right subaxillary small incision at the right axilla has high success rate and few complications.