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目的:探讨经导管途径治疗室间隔缺损(VSD)的可行性及近期疗效。方法:2003年12月至2005年3月采用VSD封堵器对13例(男8例,女5例)VSD(4例合并膜部瘤)患者进行封堵治疗。患者年龄4~35岁,平均(15.2±10.7)岁,胸部超声提示VSD的直径为4~12 mm,平均(5.4±1.2)mm。在X线透视及超声监视下通过建立轨道、经右心系统释放封堵器,并分别于术后1、3和6个月进行随访。结果:12例患者封堵器置入成功,成功率为92%。术后即刻超声及造影显示完全封堵11例,微量残余分流1例,10 min后造影显示分流消失。术后出现完全性右束支传导阻滞1例,但无心肌受损表现,余无其他严重并发症。1例嵴内型VSD由于距主动脉较近,封堵未成功。结论:采用经导管途径治疗VSD是安全有效的、近期效果良好,但远期效果有待更大规模的临床观察。
Objective: To investigate the feasibility and short-term curative effect of transcatheter treatment of ventricular septal defect (VSD). Methods: From December 2003 to March 2005, 13 patients (8 males and 5 females) VSD (4 membranous neoplasms) were treated with VSD occluder. Patients were 4 to 35 years old (mean, 15.2 ± 10.7 years). Chest ultrasound revealed a VSD diameter of 4 to 12 mm with an average of 5.4 ± 1.2 mm. The occluders were released through the right heart system through orbital pathways under X-ray and sonographic monitoring and were followed up 1, 3 and 6 months after surgery respectively. Results: In 12 patients, occluder implantation was successful with a success rate of 92%. Immediate ultrasound and angiography showed complete occlusion in 11 cases, trace residual shunt in 1 case, 10 min after angiography showed shunt disappeared. There was 1 case of complete right bundle branch block after operation, but no myocardial damage, no other serious complications. One case of crestal VSD was closed to the aorta and the occlusion was unsuccessful. Conclusion: Transcatheter treatment of VSD is safe and effective, with good results in the near future, but the long-term effect needs further clinical observation.