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室间隔缺损介入治疗后并发封堵器移位的原因分析(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2005年第2期
页码:
172-173
栏目:
介入治疗
出版日期:
2005-03-05

文章信息/Info

Title:
Analysis of occluder displace after transcatherter occlusion of ventricular septal defect
作者:
张玉顺;  李寰;  代政学;  李军;  张军;  王晓燕
第四军医大学西京医院心血管内科， 陕西 西安 710032
Author(s):
ZHANG Yushun;  LI Huan;  DAI Zhengxue;  LI Jun;  ZHANG Jun;  WANG Xiaoyan
Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi′an Shaanxi 710032
关键词:
室间隔缺损;  介入治疗; 封堵器
Keywords:
ventricular septal defect;  interventional therapy;  occluder
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的 探讨经导管介入治疗室间隔缺损（VSD）发生封堵器移位的原因和预防措施。方法 介入治疗后封堵器移位患者4（男3，女1）例，3例为膜周部VSD伴膜部瘤，1例为嵴内型VSD，缺损直径分别为13、12、12和10 mm，所选用的封堵器分别为16、12 mm国产对称型膜部VSD封堵器，14 mm Amplatzer膜部VSD封堵器和14 mm国产偏心型膜部VSD封堵器。结果 4例均一次性封堵成功。术后即刻均无残余分流。2例在术后4和12 h分别发生溶血，超声心动图检查封堵器位置无明显变化，但均有明显残余分流。经药物治疗后，溶血恢复正常，残余分流消失。1例术后第4天，心电图检查为Ⅲ度房室传导阻滞，超声心动图发现封堵器明显向囊袋出口移位。转心脏外科手术取出封堵器并修补缺损，术后患者Ⅲ度AVB恢复。1例嵴内型VSD术后2周，超声心动图发现封堵器向右心室移位，有明显残余分流。随访4个月残余分流减少。结论 VSD封堵治疗后，封堵器移位与缺损的病理解剖特性有关。多发生在伴有膜部瘤的膜部VSD和嵴内型VSD。
Abstract:
AIM To investingate the reasons of occluder displace and its preventive measures after transcatheter occlusion of ventricular septal defect (VSD). METHODS 4 (3 male, 1 female) cases happened occluder displace after transcatheter occlusion of VSD. Of whom 3 cases were perimembranous VSD with membranous ventricular septal aneurysm, 1 case was VSD. The diameter of defects were 13, 12, 12, and 10 mm, respectively. The implanting occluders were 16 mm, 12 mm domesticmade concentric VSD occluder, 14 mm Amplatzer VSD occluder, and 14 mm domesticmade eccentric VSD occluder, respectively. RESULTS The four cases were all successfully implanted with once try, and had no residual shunt immediately after occlusion. 2 cases happened haemolysis in the 4 h and 12 h of postocclusion, and both occluders position were not found significant change, but both had significant residual shunt. After treated with drugs, both haemolysis were recovery and residual shunt were disappeared. 1 case in the 4 d of postocclusion, ECG found thirddegree atrioventricular block and echocardiography found occluder obviously displaced to the outlet of membranous aneurysm. The case had to be transferred to surgically remove occluder and repair VSD, and thirddegree atrioventricular block was recovered after surgery. 1 case with VSD, 2 weeks after occlusion, echocardiography found occluder was displaced to the right ventricular and had obviously residual shunt. 4 months followup, residual shunt examined by echocardiography was diminished. CONCLUSION Transcatheter occlusion of VSD, occluder displace is associated with VSD pathological anatomy. Occluder displace mostly happened in the perimembranous VSD with membranous ventricular septal aneurysm and VSD.

参考文献/References

［1］ Hijazi ZM, Hakim F, Haweleh AA, et al. Catheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: Initial clinical experience［J］. Catheter Cardiovasc Interv， 2002, 56:508-515.

［2］周达新，葛均波，陈灏珠,等, 室间隔缺损封堵治疗的疗效和安全性［J］. 中华心血管病杂志，2003，31：330－333.

［3］张玉顺，代政学，贾国良,等，国产双盘状封堵器经导管治疗膜部室间隔缺损疗效的初步评价［J］。心脏杂志，2002，14：518－520.

［4］ Bass JL, Kalra GS, Arora R, et al. Initial human experience with the Amplatzer perimembranous ventricular septal occluder device［J］. Cathet Cardiovasc Interv, 2003,58:238-245.

［5］ Gu X，Han YM，Titus JL，et a1．Transcatheter closure of membranous ventricular septal defects with a new nitino1 prosthesis in a natural swine model［J］．Catheter Cardiovasc lnterv， 2000,50:502-509.

备注/Memo

备注/Memo:
收稿日期：2004-12-30.基金项目：陕西省自然科学基金资料（项目编号：2003C2053）
更新日期/Last Update: 2010-01-05