小腰大边型封堵器堵闭膜部瘤室间隔缺损68例观察

目的:探讨小腰大边封堵器堵闭室间隔膜部瘤缺损(PPVS)的不同部位的疗效及并发症.方法:对68例室间隔缺损(VSD)伴膜部瘤患者进行小腰大边封堵器介入治疗,术中左室造影,根据瘤体形态分为4种类型,选择4～14 mm封堵器选择不同部位进行封堵.术后24 h、1个月、3个月、6个月、12个月予以胸片、心电图、经胸超声心动图检查.结果:本组68例采用细腰大边封堵器进行封堵室间隔缺损(VSD)的患儿中,62例成功(91%).术后24 h复查超声心动图,8例少量残余分流.术后1年复查残余分流消失.9例传导阻滞患者心电图3个月内均恢复正常.结论:小腰大边封堵PPVS是安全和可行的方法,并发症少,但需正确判断膜部瘤的大小、形态、位置及瓣膜功能.

Clinical observation of interventional therapy of using thin-waist-big-side occluder to 68 cases of perimembranous ventricular septal defect with aneurysm

Aim:There are some limitations on closure of perimembranous ventricular septal defect with pseudoaneurysm (PPVS) with symmetrical and non-decenter type oceluders. This study try to evalu-ate the effectiveness and complications of interventional therapy using A4B2 (thin-waist-big-side type)occluder to PPVS. Methods: The ventricular septal defects with aneurysems were classified into four types and measured by left ventriculography. The diameter of the occludem ranged from 4 to 14 mm.TTE, chest X-ray film and electrocardiogram (ECG) were performed 1,3,6 and 12 months later to evalu-ate the efficacy. Results: Among the 68 patients, transcatheter closures were successfully conducted to 62 patients, the success rate was 91%. Residual shunt was found by transthroacic echocardiograohy (TTE) in 8 patients 24 hours later and disappeared in 12 months. Transient block in 9 patients disap-peared 3 months later. Conclusion: Interventional therapy with A_4B_2 occluder to perimembranous ven-tricular septal defect with pseudoaneurysm is safe,effective and promising,and has fewer complications.The key point is to select the suitable positions and right occluder,according to the size,position,mor-phologic characters and valve function.