自制双盘状室间隔缺损封堵器经导管闭合小儿膜周部室间隔缺损

Transcatheter closure of perimembranous ventricular septal defects in children with self-made double-disc occluder

目的:探索应用自制双盘状室间隔缺损封堵器经导管闭合小儿膜周部室间隔缺损的可行性、安全性和疗效。方法:18例先天性心脏病膜周部室间隔缺损患儿,男10例,女8例,年龄1～12(7.6±3.2)岁,体质量12～65(28.6±14.8)kg。经临床体检、心脏超声和左心室造影确诊。用7F输送鞘管经股静脉送入自制双盘状封堵器,封堵后重复左心室造影和经胸心脏超声检查,观察封堵的即刻效果。术后连续心电监护5 d。结果:17例患儿左心室造影测量室间隔缺损直径3～7(3.9±1.2)mm,所用封堵器直径为4～10(6.1±1.6)mm,封堵均获成功,10 min后左心室造影、心脏超声检查均显示无残余分流,封堵器不影响主动脉瓣关闭。1例患儿因封堵器到位后心脏超声及主动脉根部造影显示主动脉瓣中度反流而放弃封堵。17例患儿随访1～10个月,无其他并发症。结论:应用自制双盘状室间隔封堵器经导管闭合小儿膜周部室间隔缺损是一种可行、安全、有效的方法,近期疗效良好。

Objective:To investigate the safety and efficacy of transcatheter closure of perimembranous ventricular septal defects(VSD) by using self-made double-disc occluder in children. Methods: Transcatheter closures were attempted in 18(10 boys and 8 girls) children with perimembranous ventricular septal defects. Patients ranged in age from 1 to 12 years [(7. 6 ± 3. 2) years]. The body mass ranged from 12-65(28. 6 ± 14. 8) kg. All patients were diagnosed by the physical examination, e-chocardiography and left ventriculography. A 7 F delivery sheath was advanced across the VSD over a wire from femoral vein to deploy the occluder. Left ventriculography and transthoracic echocardiography were repeated to assess results of the closure. Continuous electrical cardiograph monitoring lasted for 5 d. Results: The angiographic diameter of the defects ranged from 3-7(3. 9 ± 1. 2) mm; the diameter of occluder was 4-10(6. 1± 1. 6) mm. The occluders were successfully deployed in 17 patients. No residual shunt was found by left ventriculography 10 min after the procedure. Moderate aortic regurgitation was found by the transthoracic echocardiography and angiography in 1 patient after the occluder was positioned within the VSD, and the occluder was retrieved. No complications occurred in all patients during 1-10 months follow-up. Conclusion: Transcatheter closure of perimembranous ventricular septal defects with self-made nitinol occluder in children is a safe and effective method.