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目的回顾性分析因介入失败或严重并发症需行外科手术取出封堵器的先天性室间隔缺损(VSD)患儿的资料,总结其经验教训。方法收集2003年3月-2009年12月行封堵器取出术的VSD患儿14例,分析其临床资料,VSD大小、形态,使用的封堵器型号,介入治疗并发症,外科手术中所见及手术效果等。对比有残余分流组和无残余分流组VSD和封堵器大小有无差异。结果 14例患儿平均年龄6.5岁(3.0～12.3岁);体质量21.3kg(13.5～40.0kg)。VSD均为膜周型,12例为膜周流入道型伴膜部瘤,左室面大小4～15mm,封堵器大小6～10mm。有残余分流组与无残余分流组VSD和封堵器大小比较差异均无统计学意义(t=1.074,P=0.388;t=0.691,P=0.523)。介入治疗并发症包括残余分流6例(3例并机械性溶血),瓣膜损伤5例(三尖瓣狭窄3例、重度三尖瓣返流和中度主动脉瓣返流各1例),完全性房室传导阻滞(cAVB)2例(年龄均为4岁,1例术中出现完全性右束支传导阻滞),封堵器成形不良不能回收1例。14例患儿均在全麻和体外循环下行封堵器取出及VSD修补术,全部痊愈出院,手术效果满意,无新增严重并发症。结论常见的VSD封堵术严重并发症包括cAVB、瓣膜损伤和残余分流并机械性溶血,最常发生于膜周部VSD伴膜部瘤形成的患儿,应慎重对待这一类型的介入治疗,个体化选择封堵器。VSD封堵过程最常损害的瓣膜是三尖瓣。年龄小、较大的膜周流入道型VSD伴膜部瘤形成、介入术中曾出现传导阻滞的患儿可能更倾向于并cAVB。VSD封堵失败后行外科手术取出封堵器同时修补缺损是安全有效的补救措施。
Objective To retrospectively analyze the data of children with congenital ventricular septal defect (VSD) undergoing surgical removal of occluder due to failed intervention or severe complications, and to summarize the experiences and lessons learned. Methods From March 2003 to December 2009, 14 children with VSD who underwent occluder removal were enrolled in this study. The clinical data, the size and shape of VSD, the type of occluder used, the interventional treatment of complications, See and surgery effects. There was no difference in the size of VSD and occluder between the residual shunt group and the residual shunt group. Results The average age of 14 children was 6.5 years old (3.0-12.3 years). The body weight was 21.3kg (13.5-40.0kg). VSD were membranous, 12 cases of membranous inflow with condyloma, left ventricular surface size 4 ~ 15mm, occluder size 6 ~ 10mm. There was no significant difference in the size of VSD and occluder between the residual shunt group and the residual shunt group (t = 1.074, P = 0.388; t = 0.691, P = 0.523). Interventional complications included residual shunt in 6 cases (3 cases with mechanical hemolysis), valve injury in 5 cases (tricuspid valve stenosis in 3 cases, severe tricuspid regurgitation and moderate aortic regurgitation in 1 case), complete 2 cases of atrioventricular block (cAVB) (age 4 years old, 1 case of complete right bundle branch block), failed occlusion device can not be recovered in 1 case. All 14 patients underwent occlusion removal and VSD repair under general anesthesia and cardiopulmonary bypass. All patients were discharged and discharged satisfactorily with no new serious complications. Conclusions The common complications of VSD closure include cAVB, valvular injury and residual shunt with mechanical hemolysis, most commonly occurring in children with VSD with membranous neoplasms. Careful treatment of this type of interventional therapy, Individual selection occluder. The most damaging valve in the VSD occlusion procedure is the tricuspid valve. Small age, large peritumoral flow into the type VSD with membranous tumor formation, interventional surgery had occurred in children with conduction block may be more inclined and cAVB. Surgical removal of the occluder after VSD closure fails and repairing the defect is a safe and effective remedy.