论文部分内容阅读
目的总结评价Amplatzer法介入治疗膜部室间隔缺损的方法及临床治疗效果。方法 308例膜部室间隔缺损的患儿,应用Amplatzer封堵器行室间隔缺损封堵术。造影结果显示室间隔缺损口平均(5.8±3.1)mm,其中69例伴有膜部瘤形成,7例为多发孔型缺损,4例为嵴内型缺损,3例造影显示有轻度主动脉瓣脱垂。结果 308例患儿中295例(95.8%)封堵成功,其中257例应用对称型封堵器,22例应用非对称型封堵器,16例应用小腰大边型封堵器。手术时间(68±31)min,X线透视时间(27±18)min。所选的封堵器大小为(7.8±2.5)mm。69例伴有膜部瘤形成的室间隔缺损患儿中68例成功封堵。4例嵴内型缺损均选用非对称型封堵器。3例造影有轻度主动脉瓣脱垂者,封堵术后行主动脉根部造影显示主动脉瓣反流消失。295例封堵成功的患儿中,术后造影显示即刻完全封堵263例(89.2%),残余分流32例(10.9%)。术后24 h超声心动图检查完全封堵者为287例(97.3%),术后1、6和12个月超声心动图检查示封堵成功的患儿均无残余分流。随访过程中无封堵器的移位及破裂。2例术后即刻出现III度房室传导阻滞,1例术后1个月出现III度房室传导阻滞,治疗3～4 d内均转为正常。结论 Amplatzer法介入治疗膜部室间隔缺损具有较高的成功率,是一种安全有效的方法,伴有膜部瘤形成的室间隔缺损是介入治疗良好的适应证,部分嵴内型缺损和伴有轻度主动脉瓣反流的病例可采用该方法。
Objective To summarize and evaluate the method and clinical effect of Amplatzer method in the treatment of membranous ventricular septal defect. Methods 308 cases of ventricular septal defect in children with Amplatzer occluder ventricular septal defect occlusion. The results of angiography showed that the average size of ventricular septal defect was (5.8 ± 3.1) mm, including 69 with membranous neoplasms, 7 with multiple perforation defects, 4 with intracristal defects and 3 with mild aorta Flap prolapse. Results A total of 295 cases (95.8%) of 308 children were successfully blocked. Among them, 257 cases used symmetrical occluders, 22 cases used asymmetric occluders and 16 cases used small occluders. The operation time (68 ± 31) min and X-ray fluoroscopy time (27 ± 18) min. The size of the occluder selected was (7.8 ± 2.5) mm. Seventy - nine cases of ventricular septal defect with membranous neoplasia were successfully occluded in 68 cases. Four cases of intracranial defects were selected asymmetric occluder. 3 patients with mild aortic valve prolapse who closed after aortic root aortic angiography showed aortic regurgitation disappeared. Among 295 children with successful occlusion, postoperative angiography showed immediate complete occlusion of 263 patients (89.2%) and residual diversion of 32 patients (10.9%). At 24 hours after echocardiography, 287 patients (97.3%) were completely blocked by echocardiography. Echocardiography at 1, 6 and 12 months after operation revealed no residual shunt in children with successful closure. During follow-up no occluder displacement and rupture. Two cases had III degree AV block immediately after operation, and one case had III degree AV block one month after operation. All patients turned normal within 3 to 4 days. Conclusion Amplatzer method is a safe and effective method for interventional therapy of ventricular septal defect in membranous segment. Ventricular septal defect associated with membranous tumor is a good indication of interventional treatment. Some intracranial defects and associated with Mild aortic regurgitation cases can use this method.