经皮封堵治疗先天性心脏病术后新发左心室假性室壁瘤1例

Percutaneous occlusion for left ventricular pseudoaneurysm after surgical repair of congenital heart disease:a case report

假性室壁瘤是一种罕见但可能致命的疾病,通常继发于心肌梗死、心脏手术、创伤和感染,在先天性心脏病术后发病率极低。传统手术治疗方法,多以外科手术切除假性室壁瘤并修补基底来治疗,手术创伤大、风险高。本病例报道1例6个月10 d诊断为左心室假性室壁瘤,先天性心脏病术后的患儿。患儿于7周接受室间隔缺损修补、房间隔缺损修补、肺动脉瓣闭式扩张术。术后3个月体检发现左心室假性室壁瘤;术后4个月,在经胸超声心动图引导下,采用经股动脉路径成功经皮封堵假性室壁瘤。术后复查证实封堵器位置良好,患儿恢复良好。该病例证明了超声引导下经皮封堵治疗儿童新发左心室假性室壁瘤的有效性和低创伤性。

Pseudoaneurysm is a rare yet potentially life-threatening condition,typically arising as a complication of myocardial infarction,cardiac surgery,trauma,or infection.The incidence of postoperative pseudoaneurysms in congenital heart disease patients is exceedingly low.Traditional surgical intervention involves excising the pseudoaneurysm and repairing its base;however,this approach entails significant surgical trauma and elevated risk.This case report details the diagnosis of a left ventricular pseudoaneurysm(LVPA)in a 6-month-and-10-day-old child following corrective surgery for congenital heart disease.At 7 weeks of age,the patient underwent repair for ventricular septal defect,atrial septal defect,and pulmonary valve dilation.A LVPA was identified three months postoperatively.Four months after the initial procedure,successful percutaneous closure of the pseudoaneurysm was achieved via transfemoral access under transthoracic echocardiographic guidance.Postoperative follow-up confirmed optimal positioning of the occluder and satisfactory recovery in the child.This case underscores the efficacy and minimal invasiveness associated with ultrasound-guided percutaneous closure for newly developed LVPA in pediatric patients.