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目的探讨膜周部室间隔缺损(VSD)经导管介入治疗的并发症及其预防。方法456例(男236例,女220例)膜周部VSD患者,年龄3~48岁,平均(14±9)岁。6例合并动脉导管未闭、7例合并房间隔缺损及1例合并动脉导管未闭和房间隔缺损者同时应用其他封堵装置治疗合并的畸形。结果456例患者,术前经胸超声检测VSD直径为2.3~18 mm(平均6.2 mm),VSD距主动脉右冠瓣距离0.5~6 mm(平均2.3 mm),术中心室造影测量VSD直径为1.3~20 mm(平均6.4 mm),VSD距主动脉右冠瓣距离0.5~6 mm(平均2.4 mm)。448例封堵成功。所选封堵器大小为4~22 mm(平均8.6 mm)。发生高度房室传导阻滞(AVB)6例(1.3%),溶血2例(0.4%),封堵器明显移位1例(0.2%)。6例AVB患者,5例均恢复正常窦性心率,1例安装永久起搏器。1例(0.2%)术后6月复查,有微量残余分流,1年后消失。6例(1.3%)术后新出现主动脉瓣微量返流,10例(2%)术后即刻新出现三尖瓣少量返流,1例(0.2%)术后5d新出现三尖瓣中量返流,1例(0.2%)术后6月新出现三尖瓣少量返流。结论经导管介入治疗膜周部VSD的严重并发症发生率低,是一种安全、疗效可靠、理想的治疗方法。
Objective To investigate the complications and prevention of transcatheter closure of perimembranous ventricular septal defect (VSD). Methods A total of 456 patients (236 males and 220 females) with peripheral VSD were aged 3-48 years (average 14 ± 9 years). 6 cases with patent ductus arteriosus, 7 cases with atrial septal defect and 1 case with patent ductus arteriosus and atrial septal defect were treated with other occluder devices simultaneously. Results In 456 patients, the diameter of VSD was 2.3 ~ 18 mm (mean 6.2 mm), the distance between VSD and the right aortic coronary artery was 0.5 ~ 6 mm (mean 2.3 mm). The diameter of VSD measured by intraoperative ventricular angiography was 1.3 ~ 20 mm (average 6.4 mm), VSD 0.5 ~ 6 mm (average 2.4 mm) from the right coronary aortic valve. 448 cases of successful closure. The size of the occluder selected is 4-22 mm (average 8.6 mm). There were 6 cases (1.3%) with atrioventricular block (AVB), 2 cases (0.4%) with hemolysis and 1 case (0.2%) with obvious occlusion. 6 cases of AVB patients, 5 patients returned to normal sinus heart rate, 1 case of permanent pacemaker. One patient (0.2%) was reviewed at 6 months after operation, and a slight residual shunt disappeared after one year. In 6 cases (1.3%), auricular micro-regurgitation occurred after operation, and a small amount of tricuspid regurgitation occurred in 10 cases (2%) immediately after operation. One case (0.2%) appeared new tricuspid valve In 1 case (0.2%), a small amount of tricuspid regurgitation occurred in 6 months after operation. Conclusion The low incidence of serious complications of peritoneal VSD through catheterization is a safe, reliable and ideal treatment.