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目的探讨经导管小儿膜部室间隔缺损(perimembranous ventricular septal defects,PMVSDs)介入治疗近期并发症的原因及防治措施。方法对2002年3月—2005年12月间223例小儿PMVSDs介入治疗术中和术后(随访1～18个月)发生并发症的60例进行回顾性分析,将并发症分为严重并发症和轻微并发症两组。结果全组并发症总发生率为26.9%(60/223)。严重并发症9例(4.0%),包括三度房室传导阻滞(AVB)2例(0.9%),机械性溶血3例(1.3%),需外科手术取出封堵器4例(1.8%),其中术中封堵器卡在二尖瓣1例,术后封堵器移位1例(引起溶血),术后封堵器造成主动脉瓣中量反流2例,三度AVB经置入临时起搏器和糖皮质激素及白蛋白等治疗后7天恢复正常心律,2例溶血病例给予糖皮质激素等治疗后溶血消失。轻微并发症51例(22.8%),包括不同类型的束支传导阻滞(bundle branch block,BBB)37例(16.6%),一度AVB2例(0.9%),二度AVB1例(0.4%),新出现主动脉瓣少量反流5例(2.2%),新出现少量至中量以下三尖瓣反流6例(2.6%),除右束支传导阻滞外,其他类型的传导阻滞常规应用糖皮质激素及白蛋白等治疗,绝大多数于短期随访内恢复或好转,新出现的瓣膜反流均未做特殊处理。全组无死亡病例。结论经导管小儿PMVSDs介入治疗近期并发症以轻症为主,严重并发症发生率较低,是一种相对安全的治疗方法;远期并发症的情况需进行长期严格的随访。
Objective To investigate the causes and prevention measures of the recent complications of transcatheter pediatric children with membranous ventricular septal defects (PMVSDs). Methods A retrospective analysis was performed on 60 cases of intraoperative and postoperative follow-up (from 1 to 18 months) of 223 children with PMVSDs during the period from March 2002 to December 2005. The complications were divided into serious complications And minor complications in both groups. Results The overall incidence of complications was 26.9% (60/223). Nine cases (4.0%) had serious complications, including 2 cases of third degree AVB (0.9%) and 3 cases of mechanical hemolysis (1.3%). Surgical occlusion devices were removed in 4 cases (1.8% ), Including intraoperative occluder stuck in the mitral valve in 1 case, postoperative occluder in 1 case (causing hemolysis), occluder caused by aortic valve in the amount of reflux in 2 cases, the third AVB by Into the temporary pacemaker and glucocorticoid and albumin and other treatment 7 days after the return to normal heart rhythm, 2 cases of hemolysis glucocorticoid treatment hemolysis disappeared. 51 cases (22.8%) had minor complication, including 37 cases (16.6%) of different types of bundle branch block (BBB), 1 AVB2 case (0.9% There were 5 cases (2.2%) of newly diagnosed aortic valve regurgitation, and 6 cases (2.6%) of new to moderate tricuspid valve regurgitation. In addition to right bundle branch block, other types of block Application of glucocorticoid and albumin treatment, the vast majority of recovery or improvement in the short-term follow-up, the new valve regurgitation have not done special treatment. No deaths in the whole group. Conclusions The recent complication of PMVSDs in pediatric pediatric patients is mainly mild and the incidence of serious complications is low. It is a relatively safe treatment for long-term follow-up of long-term complications.