应用Amplatzer偏心性封堵器介入治疗膜部室间隔缺损

Clinical application of Amplatzer occluder device to treat perimembrane ventricular septal defect: a report of 6 cases for transcatheter closure of VSD

目的 应用Amplatzer偏心性封堵器治疗膜部室间隔缺损 (perimembraneventicularseptaldefect,PMVSD)并对近期疗效进行观察。方法 6例PMVSD患者均经胸超声心动图确诊 ,术中经左心室造影明确缺损直径为 3～ 9mm ,平均 5 5mm ;经左心系统、室间隔缺损处、右心系统建立导丝轨迹 ,沿导丝经传送鞘管送直径 6～ 12mm(平均 8mm)的Amplatzer封堵器至缺损处行封堵 ;术后 2 4h、1月、3月分别行经胸超声及X线检查观察临床疗效。结果 全组技术成功率 10 0 % ,术中未发生任何重要并发症。全部患者封堵后无一例存在残余分流 ,术后即刻完全封堵率 10 0 % ;术后 2 4h、1月及 3月经胸超声心动图检查无残余分流 ,X线检查全部显示肺血减少 ,心胸比例不同程度缩小。 1例患者术后出现完全性左束支传导阻滞 ,1月随访时消失。结论 经导管置入Amplatzer偏心性膜部室间隔缺损封堵器治疗PMVSD是一种成功率高、近期疗效可靠的介入方法 ,其远期疗效需进一步观察。

Objective To evaluate the therapeutic effect of transcatheter closure of perimembrane ventricular septal defect (PMVSD) using Amplatzer eccentric perimembrane VSD occluder device Methods Six patients with a mean age of 24 2 years (ranging from 11 to 41 years), were each treated with Amplatzer occluder device through the percutaneous procedure under fluoroscopy, angiography and TTE The TTE and chest film were performed 24 hours, 1 and 3 months after the procedure to evaluate its therapeutic effect Results The success rate was 100%, and no complications occured during the procedure The mean diameter of the VSDs was 5 5 mm (ranging from 3 to 9 mm) The mean diameter of the occluder selected was 8 mm (ranging from 6 to 12 mm) No residual shunts were found in the 6 cases after the procedure 24 hour, 1 and 3 months X ray examination showed that both pulmnary vascularity and heart size were improved Conclusion Transcatheter closure of perimembrane ventricular septal defect using Amplatzer occluder device is an efficient method for patients with PMVSD The operation is simple with a high success rate of placement and a good occlusion effect