应用改良的动脉导管未闭封堵器经导管闭合三尖瓣腱索附着异常的膜周部室间隔缺损

Transcatheter closure of perimembranous ventricular septal defects with abnormally attached tricuspid chordae tendineae using an improved patent ductus arteriosus occlude

目的探讨应用改良的国产动脉导管未闭(patent ductus arteriosus,PDA)封堵器经导管闭合三尖瓣腱索附着异常的膜周部室间隔缺损(perimembranous ventricular septal defect,pmVSD)的安全性和可行性。方法选择2011年12月~2019年12月在西安交通大学第一附属医院结构性心脏病科诊断为pmVSD并伴有三尖瓣腱索附着异常的患者(n=35),应用改良的国产PDA封堵器介入治疗,对其基线特征、经导管操作和随访数据进行回顾性分析。结果所有患者(100%)手术成功,术中无传导阻滞发生。1例(2.9%)于术后48 h内发生一过性完全右束支传导阻滞,静脉推注地塞米松3 d后心电图恢复正常。35例(100%)患者经胸超声心动图(transthoracic echocardiography,TTE)检查均未观察到残余分流。在平均(4.4±2.3)年的随访期内,1例(2.9%)三尖瓣返流(tricuspid regurgitation,TR)较术前增加,为中量TR,其余患者未观察到严重的TR或TR加重。结论使用改良的PDA封堵器经导管闭合三尖瓣腱索附着异常的pmVSD是一种安全、有效的治疗选择,未发现严重的TR及其它并发症。

AIM To explore the feasibility and safety of transcatheter closure of perimembranous ventricular septal defects(PmVSD)with abnormally attached tricuspid chordae tendineae using an domestic improved patent ductus arteriosus(PDA)occluder.METHODS We retrospectively analyzed 35 patients diagnosed as PmVSD with abnormally attached tricuspid chordae tendineae who underwent interventional treatment using an improved PDA occluder at our center from December 2012 to December 2019.Baseline characteristics and procedural and follow-up data were analyzed.RESULTS All 35 patients(100%)achieved procedure success.No heart block occurred during the operation.One patient(2.9%)had a transient complete right bundle branch block within 48 h post-procedure and reverted to normal rhythm after intravenous injections of dexamethasone for 3 d.No residual shunt was observed in the 35 patients(100%)by transthoracic echocardiography(TTE)post-procedure.During the average follow-up period of(4.4±2.3)years,1 case(2.9%)had an increase in tricuspid regurgitation(TR)compared with preoperatively,which was a moderate amount of TR.No severe TR or aggravated TR was observed in the remaining patients.CONCLUSION Improved PDA occluder for the transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae is a safe and promising treatment option.However,long-term follow-up in a larger group of patients is still warranted.