全军室间隔缺损10年介入治疗现状分析

Analysis of 10-year interventional therapy for ventricular septal defect in military hospitals in China

目的总结全军心血管介入诊疗管理信息网注册登记自2011年1月~2020年12月开展室间隔缺损(ventricular septal defect,VSD)介入治疗情况及并发症等信息,为今后开展VSD介入治疗提供指导和借鉴。方法通过全军心血管介入诊疗管理信息网注册登记收集全军各医院2011年1月~2020年12月介入治疗VSD的病例资料,包括实施介入治疗VSD数量、类型、所使用的介入治疗器材、成功病例数、复合畸形情况、失败原因和并发症等项目,然后进行数据统计学分析。结果 10年期间共进行介入治疗7 293例,成功7 063例,成功率96.8%。介入治疗VSD类型包括膜周部VSD 6 662例,肌部VSD 199例,嵴内型VSD 314例,VSD修补术后残余瘘43例、VSD封堵术后残余瘘2例以及心梗后室间隔穿孔73例。在所有封堵术治疗中,进口封堵器使用率仅为11.9%,而国产封堵器使用率高达88.1%。共记录主要并发症39例,发生率0.53%,其中心脏传导阻滞发生率最高,22例占比达0.30%,占全部并发症的56.4%,封堵器脱落4例,主动脉瓣关闭不全5例,心包填塞1例,重度残余分流5例,死亡2例。相对于2011年1月~2015年12月,2016年1月~2020年12月介入治疗病例成功率显著升高,并发症发生率呈现明显降低趋势。结论随着介入治疗经验的成熟,经严格筛选的膜周部VSD、嵴内型VSD、VSD外科修补术/封堵术后残余瘘以及心梗后室间隔穿孔的介入治疗已成为安全有效的方法,但需要长期随访。

AIM To summarize the results of interventional treatment and complications of ventricular septal defect(VSD)registered from January 2011 to December 2020 in the PLA cardiovascular interventional treatment management information network,in order to provide guidance and reference for the interventional treatment of VSD in the future.METHODS The data of VSD cases treated by interventional therapy in military hospitals from January 2011 to December 2020 were collected through the registration of cardiovascular interventional therapy management information network,including the number of VSD cases treated by interventional therapy,the types of VSD,the transcatheter devices used,the success rate,the complex malformations,the causes of failure and the complications,and the data were analyzed statistically.RESULTS Successful interventional therapy was achieved in 7063 out of7293 patients(96.8%)with VSD in the past 10 years,the types of VSD included perimembranous VSD in 6662 cases,muscular VSD in 199 cases,intracristal VSD in 314 cases,residual fistula after VSD repair in 43 cases,residual fistula after VSD closure in 2 cases,and ventricular septal perforation after myocardial infarction in 73 cases.Up to 88.1%patients underwent transcatheter closure with China-made devices.The incidence of procedure related major complications was 0.53%(n=39),which were most frequently associated with conduction blockades(n=22).There were also 4 cases of occluder migration,5 cases of aortic insufficiency,1 case of pericardial tamponade,5 cases of moderate to severe residual shunt,and 2 cases of death.Compared with that in the period from January 2011 to December 2015,the success rate of interventional treatment increased significantly from January 2016 to December 2020,and the incidence of complications decreased significantly.CONCLUSION With the accumulation of interventional therapy experience,interventional therapy becomes a safe and effective method for patients with perimembranous VSD,intracristal VSD,residual fistula after VSD surgical repair/occlusion and ventricular septal perforation after myocardial infarction,and it needs long-term follow-up.