偏心型封堵器治疗先天性干下型室间隔缺损的探讨

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1、【摘要】目的探讨先天性干下型室间隔缺损(VSD)偏心型封堵器介入治疗的可行性及近期疗效。方法经皮介入治疗先天性干下型室间隔缺损患者7例。经胸超声心动图提示VSD的直径为4～8mm，缺损上缘距主动脉瓣的距离1～2mm,距肺动脉瓣距离4～6mm，轻度主动脉瓣反流6例，中度1例。均选用偏心型VSD封堵器治疗。术中在右前斜45度下行左室造影、建立股动静脉轨道、经右心系统释放封堵器，并分别于术后2周、1个月、3个月、6个月进行随访。结果7例患者封堵器均成功置入。术后即刻超声及造影示完全封堵6例，少量残余分流1例，在3个月后消失。封堵器

2、对主动脉瓣、肺动脉瓣和房室瓣均无影响，术中及术后未有其它严重并发症发生。结论应用偏心型封堵器经皮介入治疗先天性干下型室间隔缺损是安全有效的，近期效果良好。【关键词】室间隔缺损干下型心导管术封堵器TranscatheterClosureofCongenitalSubarterialVentricularSeptalDefectusingAsymmetricVentricularSeptalDefectOccluder.CHIJu_fang,GUOHang_yuan,PENGFang,etal.DepartmentofCardi

3、ology,Shaoxingpeople'shospital.Zhejiang312000,China［Abstract］ObjectiveTostudythefeasibilityandefficacyoftranscatheterclosureofcongenitalsubarterialventricularseptaldefect(VSD).MethodsFromMarch2006toMay2007,7patientswithsubarterialVSDunderwenttranscatheterclosure.Th

4、ediameterofVSDmeasuredbytransthoracicechocardiographywasrangedfrom4to8mm.Thedistancebetweensuperiorborderofdefectandaorticvalvewasrangedfrom1to2mm.Thedistancebetweensuperiorborderofdefectandpulmonaryvalvewasrangedfrom4to6mm.AsymmetricVSDoccluderwasusedforallpatient

5、s.Allpatientsunderwentleftventriculographybeforecatheterclosureandrecheckedechocardiography,ECG,chestX_rayat2weeks,1month,3monthsand6monthsaftertheprocedures.ResultsThedeviceswereimplantedsuccessfullyinallpatients.6patientswithVSDclosedimmediately,andmildresidualsh

6、untwasfoundin1patient.Theresidualshuntdisappearedwithin3monthsfollow_upperiod.Therewerenovalvularinsufficiencyandnootherseverecomplications.ConclusionsTranscatheterclosureofsubarterialVSDwithasymmetricVSDoccludeissafeandeffective,short_termoutcomeisgood.［Keywords］S

7、ubarterialventricularseptaldefect;Heartcatheterization;Closure单纯室间隔缺损(Ventricularseptaldefect,VSD）是最常见的先天性心脏病之一，约占所有先天性心脏病的20%［1］。自1988年Lock等［2］首次报道经导管室间隔缺损封堵术，其后发展用于治疗肌部和膜周部缺损。但干下型缺损仍被认为不是介入治疗的适应症［3］。本文总结7例先天性干下型室间隔缺损患者采用偏心型封堵器行介入治疗的成功率和近期疗效，并探讨其适应症和手术操作方法。1资料与方法1

8、.1病例资料：2006年3月至2007年5月我院经临床确诊的7例先天性干下型VSD患者，其中男4例，女3例，年龄16～64岁，体重46～73kg。超声心动图彩图见封三：大动脉短轴切面示室间隔缺损均在12～1点钟方向，缺损直径4～8mmlocatedintheTomb,DongShenJia