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目的探讨室间隔缺损(VSD)经导管介入治疗的并发症与防治。方法 2004年12月至2008年12月,360例室间隔缺损患者,年龄3～36岁,体重11～65kg。膜周部VSD334例,嵴内型VSD26例,并发动脉导管未闭8例,并发房间隔缺损12例。结果 360例患者术前经胸超声检测VSD大小为3～12mm,术中心室造影测量VSD大小为2.6～13mm,347例(347/360)封堵成功。所选封堵器大小为4～16mm。无死亡病例,严重并发症6例(6/360)。其中高度房室传导阻滞(AVB)5例(5/360);溶血1例(1/360);2例术中出现AVB,收回封堵器,1例1个月后再次手术成功;1例术后24h出现AVB治疗5d仍未恢复,急诊外科手术后恢复窦性心律;2例术后1年出现Ⅲ°AVB,均行起搏治疗。溶血患者经输血,常规治疗后恢复正常。未见封堵器明显移位。其他并发症有:5例术后1周有微量残余分流,1个月后复查2例消失,3个月后复查3例消失;7例术后心出现主动脉瓣微量返流,6例术后出现三尖瓣微量返流;35例术后出现间歇性加速性交界性心律,治疗后均恢复正常;28例术后出现不完全性或完全性右束支传导阻滞,2例术后出现完全性左束支传导阻滞,治疗后恢复正常。结论经导管介入治疗室间隔缺损的严重并发症发生率低,是安全,疗效可靠的治疗方法 。
Objective To investigate the complications and prevention and treatment of transcatheter arterial septal defect (VSD). Methods From December 2004 to December 2008, 360 patients with ventricular septal defect, aged 3 to 36 years, weighing 11 to 65 kg. There were 334 cases of VSD, 26 cases of intracristal VSD, 8 cases of patent ductus arteriosus and 12 cases of atrial septal defect. Results 360 cases of patients with preoperative transthoracic ultrasound detection of VSD size of 3 ~ 12mm, intraoperative ventriculography VSD size of 2.6 ~ 13mm, 347 cases (347/360) successfully blocked. The size of the occluder selected is 4 ~ 16mm. No deaths, severe complications in 6 cases (6/360). Among them, 5 cases (5/360) had atrioventricular block (AVB) and 1 case (1/360) had hemolysis. AVB occured in 2 cases and occluder was withdrawn in 1 case. For example, AVB was not recovered after 5 days of operation, sinus rhythm was recovered after emergency surgery, and 2 cases of Ⅲ ° AVB occurred 1 year after operation. Hemolytic patients after transfusion, routine treatment returned to normal. No occluder obvious shift. Other complications included 5 cases of residual residual shunt after 1 week, 2 cases disappeared after 1 month, 3 cases disappeared after 3 months, and 7 cases had aortic valve regurgitation and 6 cases Tricuspid regurgitation occurred retrospectively; intermittent accelerated borderline rhythm appeared in 35 cases, and returned to normal after treatment. In 28 cases, incomplete or complete right bundle branch block was observed, and postoperative Complete left bundle branch block, returned to normal after treatment. Conclusion The low incidence of serious complications of transcatheter interventricular septal defect is a safe and effective treatment.