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目的:回顾性研究经导管介入治疗室间隔缺损(VSD)的并发症及其处理。方法:VSD介入治疗的300例(男152,女148)患者,年龄2～44(10.8±7.8)岁,回顾性统计分析所有患者术中及术后发生的并发症,并对并发症的处理进行总结。结果:手术技术成功率98%(294/300)。严重并发症8例(2.7%),无死亡病例。其中5例(1.7%)术后发生高度房室传导阻滞,经激素、异丙肾上腺素、临时起搏器等治疗后,4例恢复,1例治疗50天后仍有间歇性高度房室传导阻滞发生,植入永久起搏器治疗。另2例(0.7%)术后发生溶血,激素等治疗后,溶血均消失。1例(0.3%)患者术后4天发现封堵器移位,急诊转心脏外科手术处理。术后一过性及短期并发症有:1例(0.3%)患者术后发现少量心包积液,经静脉推注鱼精蛋白对抗肝素,止血药处理后控制;91例(30.3%)患者封堵术后即刻心脏彩色B超室间隔有微～少量残余分流,其中3例(1%)患者术后3～6个月复查仍有微量残余分流。8例(2.7%)患者术后新出现主动脉瓣微量反流,4例(1.3%)术后新出现三尖瓣少量反流。84例(28%)术后心电图(ECG)出现间歇性加速性交界性心律或加速性室性自主心律伴干扰性房室脱节,给予激素等治疗3～7天后均恢复正常。53例(17.7%)术后ECG为不完全性或完全性右束支传导阻滞,2例(0.7%)术后ECG为完全性左束支传导阻滞。27例(9%)术后ECG有室内传导阻滞。结论:采用Amplatzer偏心性膜部VSD和国产双盘状VSD封堵器经导管介入治疗室间隔缺损严重并发症发生率低,是一安色、疗效可靠、理想的治疗方法。
Objective: To retrospectively study the complications and management of transcatheter interventional ventricular septal defect (VSD). Methods: A total of 300 patients (152 males and 148 females) with interventional treatment of VSD aged 2 to 44 years (10.8 ± 7.8 years) were enrolled in this study. The complications of intraoperative and postoperative complications were retrospectively analyzed. Giving a summary. Results: The success rate of surgical technique was 98% (294/300). Serious complications in 8 cases (2.7%), no deaths. Among them, 5 cases (1.7%) had a high degree of atrioventricular block after operation. After treatment with hormone, isoproterenol, temporary pacemaker and so on, 4 cases recovered, and one case still had intermittent atrioventricular conduction Block occurred, implanted permanent pacemaker treatment. The other two cases (0.7%) occurred hemolysis after surgery, hormones and other treatment, hemolysis disappeared. In 1 patient (0.3%), occluder displacement was found 4 days after operation and cardiac surgery was performed in emergency department. Postoperative transient and short-term complications were: a small amount of pericardial effusion was found in 1 patient (0.3%), protamine was administered intravenously against heparin, and hemostatic drugs were administered after treatment. 91 (30.3%) patients Immediate closure of the heart color B ultrasonographic interval slightly ~ a small residual shunt, of which 3 cases (1%) patients 3 to 6 months after the review there are still traces of residual shunt. Aortic valve regurgitation occurred in 8 patients (2.7%). A small amount of tricuspid regurgitation occurred in 4 patients (1.3%). Eighty-four patients (28%) had intermittent accelerated borderline arrhythmias or accelerated ventricular autonomic arrhythmias with disturbed atrioventricular disconnection after operation. All patients returned to normal after 3-7 days of treatment with hormones. Fifty-three patients (17.7%) had incomplete or complete right bundle branch block (ECG) postoperative ECG and 2 patients (0.7%) postoperative ECG with complete left bundle branch block. 27 cases (9%) ECG postoperative conduction block. CONCLUSION: Amplatzer eccentric diaphragm VSD and domestic dual disc VSD occluder are the ideal therapy for the treatment of serious ventricular septal defect with low incidence of complications due to catheterization.