论文部分内容阅读
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AGAAmplatzer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。
Objective To evaluate the efficacy and complications of transcatheter interventional therapy of congenital ventricular septal defect (VSD). Methods From 2005 to 2007, 90 cases of VSD were treated in our department and 86 cases were treated by catheterization. The clinical data, preoperative and postoperative ECG, echocardiography, intraoperative angiography, selection of occluder and follow-up data were retrospectively reviewed Sexual analysis. Results 90 cases of VSD patients, 40 males and 50 females, age distribution of 2 to 34 years (mean 8.9 years). 87 cases were membranous ventricular septal defect, 3 cases were intracristal, 1 case was residual fistula after VSD surgical repair, 1 case had patent ductus arteriosus (PDA). 86 cases of successful closure, the technical success rate was 95.6%. VSD right ventricular maximum diameter of 1.5 ~ 8.8mm, implanted occluder diameter of 4 ~ 18mm. 17 cases were treated with AGAAmplatzer occluder, 13 cases were made domestically with small waist and large occluder, 52 cases were made concentric circular occluder, and 2 cases were made with eccentric occluder. The average follow-up time was 18 months. The complications included 30 cases of complete right bundle branch block (CRBBB), 2 cases of incomplete right bundle branch block (ICRBBB), 7 cases of left anterior branch block (LABB), 7 cases of CRBBB and LABB1 For example, one patient had intermittent third degree AVB during operation, two patients had alternating CRBBB and complete left bundle branch block (CLBBB) after surgery, 6 patients had accelerated borderline autonomic arrhythmias, All transient, followed up for 1 week ~ 3 months disappeared. Residual shunt in 3 cases, including 1 case of mechanical hemolysis, symptomatic improvement after discharge. Aortic valve a small amount of reflux in 2 cases, tricuspid regurgitation in 3 cases, were a small amount of ~ in the amount of reflux, no special treatment. Conclusion Transcatheter closure of VSD is a safe and effective treatment. High success rate of surgery, less serious complications, conduction block is the main complication of VSD interventional therapy, timely detection and timely treatment is the key to the treatment of the long-term impact of the intracardiac conduction system needs further evaluation.