室间隔缺损封堵治疗的疗效和安全性

Appraisal of efficacy and safety of ventricular septal defects device occlusion

目的 应用国产和进口室间隔缺损 (室缺 )封堵器封堵室缺 ,通过 3～ 6个月的随访来评价其疗效和安全性。方法 30例室缺患者 ,男性 12例 ,女性 18例 ,年龄 6～ 4 2岁 ,体重 2 6～ 77(45 3±2 1 4 )kg ,身高 1 31～ 1 76m。 2 8例为室间隔膜部缺损 ,其中 14例患者伴有室间隔膜部瘤 ;另 2例为嵴下型室缺。本组最初 3例使用经食管超声心动图 (TEE)监测 ,以后 2 7例使用经体表超声心动图 (TTE)监测。封堵器选用国产封堵器 2 5例、Amplatzer 3例。室缺封堵术后 72h进行TTE复查 ,术后 1个月、3个月、6个月随访心电图、TTE、X线 ,观察疗效和安全性。结果 2 8例封堵手术成功 ,即刻手术成功率93 3% ,无残余分流 ,对主动脉瓣无影响 ,对房室瓣无影响 ,无血管内溶血。 14例伴有室间隔膜部瘤的患者成功封堵。术后次日有 1例出现非阵发性交界性心动过速伴干扰性房室分离 ,经使用肾上腺皮质激素治疗后缓解。 2 8例术后 72h复查TTE ,均无残余分流 ,主动脉瓣、房室瓣均无影响 ,经过 1个月、3个月、6个月的随访 ,原有临床不适症状缓解 ,未发现有发热、栓塞、感染性心内膜炎等临床表现 ,TTE显示封堵器位置稳定 ,室间隔水平无分流 ,主动脉瓣、房室瓣无影响。结论 室缺边缘距离半月瓣大于 3mm以上、直径 10mm以下、伴或?

Objective To evaluate the therapeutic effect and safety of transcather Amplatzer closure device of perimembranous ventricular septal defects(VSD) and closure device of VSD made in China by following up 3-6 months. Methods Thirty patients, range from 6-42 years old in age and from 26-77 (45.3±21.4)kg in weight, 1.31-1.76 m in height, among whom 12 were males and 18 were females, were studied, and 28 of them suffered from perimembranous ventricular septal defects, among whom 14 suffered from membranous aneurysm at same time, and 2 of them suffered from infracristal ventricular septal defects. The first 3 patients were monitored by transesophageal echocardiography(TEE) and the other 27 patients were monitored by transthoracic echocardiography(TTE) during the procedure. All patients were examined again by TTE after 72 h and were reexamined by TTE, ECG and X-rays after 1 month, 3 months and 6 months respectively. Results The success rate of operation were 93.3%, and there were no residual shunts after operation on the observation of TEE or TTE. No patients developed new-onset aortic or tricuspid regurgitation or intravascular hemolysis or bundle branch block. Fourteen patients suffered from perimembranous ventricular septal defects and membranous aneurysm had been successfully operated on.One patient suffered from non-paroxysmal junctional tachycardia after 24 h, and recovered after treatment with cortin.There were no residual shunt, new-onset aortic or tricuspid regurgitation after 72 h on TTE. During 3-6 months follow-up period no patient developed infective endocarditis, embolism, bundle branch block, or late valvular insufficiency. Conclusion Transcatheter closure is safe and efficacious in selected cases of VSD.