论文部分内容阅读
目的探讨流入道型室间隔缺损(IVSD)介入治疗适应证及并发症防治措施。方法采用国产室间隔缺损(VSD)封堵器对46例IVSD患儿进行封堵治疗。经胸超声心动图(TTE)显示VSD直径(6.8±5.3)mm。所有患儿在透视及超声监测下通过建立股动静脉轨道,经右心系统释放封堵器,并分别于术后1、3、6、12、24个月通过TTE、心电图检查等方法,从患儿残余分流、瓣膜功能及心律方面进行随访评价。结果封堵器置入成功40例,未成功6例,成功率82.6%;4例封堵器释放后存在少量残余分流,术后1个月超声复查残余分流消失。随访中未发现新出现的三尖瓣返流病例;2例原为少量三尖瓣返流者,封堵术后出现中量返流;1例术前伴中度三尖瓣返流,术后出现了重度返流。4例于术后3～6d出现Ⅲ度房室传导阻滞,常规应用激素等药物治疗,2例痊愈,2例置入临时起搏器8～10d完全恢复;术后出现6例完全性左束支传导阻滞,5例完全性右束支传导阻滞,2例室性期前收缩,随访3个月均完全恢复。结论部分IVSD可选择介入治疗,近中期效果良好。但应严格把握适应证,加强其并发症防治。
Objective To investigate the indications for interventional treatment of IVSD and its prevention and treatment. Methods Seventy-six cases of IVSD were treated with occluder made by domestic ventricular septal defect (VSD). Transthoracic echocardiography (TTE) showed VSD diameter (6.8 ± 5.3) mm. All children underwent fluoroscopic and ultrasound monitoring through the establishment of femoral venous orbit, the release of the occluder via the right heart, and respectively 1, 3, 6, 12, 24 months after TTE, ECG examination and other methods, from Children with residual shunt, valvular function and heart rate follow-up evaluation. Results The occluder was successfully inserted in 40 cases, 6 cases were unsuccessful, the success rate was 82.6%. There was a small amount of residual shunt after the occlusion of the occluder in 4 cases, and the residual shunt disappeared one month after the operation. No new cases of tricuspid regurgitation were found during the follow-up. Two patients had a small amount of tricuspid regurgitation and a moderate volume regurgitation occurred after closure. One patient had moderate tricuspid regurgitation After a heavy reflux. 4 cases showed Ⅲ degree atrioventricular block between 3 and 6 days after operation. Hormone and other drugs were used routinely, 2 cases were cured, 2 cases were implanted with temporary pacemaker for 8 to 10 days, and 6 cases were complete Bundle branch block, 5 cases of complete right bundle branch block, 2 cases of premature ventricular contraction, were followed up for 3 months were completely recovered. Conclusion IVSD can choose interventional therapy, the near-mid-term effect is good. However, indications should be strictly controlled to strengthen its prevention and treatment of complications.