经导管介入治疗90例室间隔缺损疗效观察

山东大学学报(医学版) ›› 2010, Vol. 48 ›› Issue (5): 89-92.

经导管介入治疗90例室间隔缺损疗效观察

赵立健,韩波,张建军,庄建新,靳有鹏,王玉林

山东大学附属省立医院儿科, 济南 250021

收稿日期:2010-01-11 出版日期:2010-05-16 发布日期:2010-05-16
通讯作者: 韩波（1964- ）,女,主任医师,儿科心血管专业。 E-mail: hanbo35@126.com
作者简介:赵立健（1975- ）,男,医学硕士,主治医师,儿科心血管专业。

Evaluation of transcatheter closure in 90 cases ofcongenital ventricular septal defect

ZHAO Lijian, HAN Bo, ZHANG Jianjun, ZHUANG Jianxin, JIN Youpeng, WANG Yulin

Department of Pediatrics,Provincial Hospital Affiliated to Shandong University, Jinan 250021, China

Received:2010-01-11 Online:2010-05-16 Published:2010-05-16

摘要/Abstract

摘要：

目的评价经导管介入治疗先天性室间隔缺损（VSD）的疗效及并发症。方法 2005~2007年我科共收治VSD患者90例,经导管介入治疗成功86例,对所有病例的临床资料、手术前后心电图、心脏超声、术中心脏造影、选择封堵器械及随访资料进行回顾性分析。结果 90例VSD患者中,男40例,女50例,年龄分布2~34岁（平均8.9岁）。87例为膜部室间隔缺损,3例为嵴内型,1例为VSD外科修补术后残余瘘,1例合并动脉导管未闭（PDA）。封堵成功86例,技术成功率为95.6%。VSD右室面最大直径为1.5～8.8mm,植入封堵器直径为4~18mm。17例采用AGA Amplatzer封堵器,13例采用国产小腰大边封堵器,52例采用国产同心圆型封堵器,2例采用国产偏心型封堵器。平均随访时间18个月。并发症30例,包括：完全性右束支传导阻滞（CRBBB）3例,不完全性右束支传导阻滞（ICRBBB）2例,左前分支传导阻滞（LABB）7例,CRBBB并LABB1例,1例术中出现间歇性Ⅲ度房室传导阻滞（AVB）,2例术后出现交替性CRBBB及完全性左束支传导阻滞（CLBBB）,加速性交界性自主心律6例,均为一过性,随访1周~3个月消失。残余分流3例,其中1例合并机械性溶血,对症处理后好转出院。主动脉瓣少量返流2例,三尖瓣返流3例,均为少量~中量返流,未行特殊处理。结论经导管封堵VSD是一种安全有效的治疗方法。手术成功率高,严重并发症少,传导阻滞是VSD介入治疗术后的主要并发症,及时发现、及时处理是治疗关键,对心内传导系统远期的影响仍需进一步评价。

关键词: 室间隔缺损；经导管关闭；并发症；随访

Abstract:

Objective To evaluate the therapeutic effect of transcatheter closure of ventricular septal defect(VSD). Methods During 2005 to 2007, a total of 90 cases diagnosed as congenital VSD were admitted to our department, of which 86 cases underwent transcatheter closure succesessfully. The clinical data including electrocardiogram and transthoratic echocardiography before and after intervention, angiogram during intervention, implanted occluder devices and followup data of all patients were analysed. Results Among the 90 patients, 40 were male and 50 were female, aged from 2 to 34 years (mean age, 8.9 years). 87 had perimembranous ventricular septal defect, 3 intercristal ventricular septal defect, 1 residual fistula after surgery repair and 1 patent ductus arteriosus. 86 cases (95.6%) were occluded successfully. The VSD diameter was 1.58.8mm. The implanted occluder device diameter was 4-18mm. Amplatzer membranous VSD occluder were used in 17 cases, home-made thin-waist-big-side occluder in 13 cases, home-made concentric occluder in 52 cases and home-made eccentric occluder in 2 cases. The average follow-up time was 18 months. 30 cases presented various complications including 3 cases of CRBBB, 2 case of ICRBBB, 6 cases of accelerated junctional tachycardia, which were all transient, disappearing after 1 week-3months. Residual shunt occured in 3 cases, and 1 case had mechanical hemolysis, which resolved 7 days later after conservative therapy. Aortic valve regur-gitation occurred in 2 cases and tricuspid regurgitation occurred in 3 cases. All the regurgitation was mild to moderate and no further treatment were performed. Conclusions Transcatheter closure of perimembraneous VSD is safe and efficacious, and the successful rate is high with rare severe complications. Conduction blockades are the main complications. It is important to be diagnosed and treated in time. Further followup studies are required to document the longterm effect on the intracardiac condution.

Key words: Ventricular septal defect; Transcatheter closure; Complications; Follow-up

中图分类号:

R725.4

赵立健,韩波,张建军,庄建新,靳有鹏,王玉林. 经导管介入治疗90例室间隔缺损疗效观察[J]. 山东大学学报(医学版), 2010, 48(5): 89-92.

ZHAO Lijian, HAN Bo, ZHANG Jianjun, ZHUANG Jianxin, JIN Youpeng, WANG Yulin. Evaluation of transcatheter closure in 90 cases ofcongenital ventricular septal defect[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2010, 48(5): 89-92.

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