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|本期目录/Table of Contents|

主动脉边缘不足2 mm膜周部室间隔缺损的介入治疗评价(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2005年第2期
页码:
198-200
栏目:
介入治疗
出版日期:
2005-03-05

文章信息/Info

Title:
Transcatheter closure of perimembranous ventricular septal defects associated with aortic rims (<2 mm)
作者:
张玉顺1; 代政学1; 李寰1; 王垒2; 张军1; 李军1
1.第四军医大学西京医院, 2.西安市儿童医院, 陕西 西安 710032
Author(s):
ZHANG Yushun1; DAI Zhengxue1;  LI Huan1; WANG Lei2;  ZHANG Jun1;  LI jun1
1. Department of cardiology,Xijing Hopital of Fourth Military Medical University, Xi′an, Shaanxi 710032,China
关键词:
膜周部室间隔缺损;  心导管插入术;  封堵器
Keywords:
ventrial septal defects;  transcatheter closure;  occluders
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的 评价距主动脉瓣2 mm以内的膜部室间隔缺损(VSD)经导管封堵治疗的可行性。方法 86(男46，女40)例患者，年龄3～48(12±9)岁。经胸超声检测VSD距主动脉右冠瓣0.5~2(平均1.2) mm，VSD直径3～18(7±4) mm。其中22例有轻度肺动脉高压，2例有轻~中度肺动脉高压。19例伴轻度主动脉右冠瓣脱垂。结果 左心室造影测量VSD直径为4~18(平均7) mm，VSD距主动脉右冠瓣0.5~2(平均1.2) mm。84例患者封堵成功，2例伴主动脉右冠瓣轻度脱垂封堵后有少~中量主动脉瓣返流而放弃封堵，成功率为98%。所选封堵器大小为5~22 (平均8.4) mm。封堵器到位后即刻左心室和升主动脉造影显示，微量残余分流7例，微量主动脉瓣返流5例。3月超声复查有1例微量主动脉瓣返流，均无残余分流。术后发生高度AVB 1例，经药物治疗恢复。结论 距主动脉瓣2 mm以内的膜部VSD可以成功经导管封堵治疗，其远期疗效尚需长期临床观察。
Abstract:
AIM To evaluate the feasibility of transcatheter closure of perimembranous ventricular septal defects (VSDs) associated with aortic rims (<2 mm) . METHODS 86 patients (male 46,female 40) underwent attempted transcatheter closure of a VSDs at a median age of 12±9 years (range 3.0 to 48.0) . The distance of VSDs to aortic right valve was 0.5~2(average 1.2)mm.Among them 22 cases associated with small pulmonary hypertension,2 cases with small to moderate pulmonary hypertension.19 cases associated with light aortic right valve prolapse. RESULTS The mean VSD diameter at its left ventricular side was 7 mm (rang 4.0 to 18.0), the distance of VSDs to aortic right valve was 0.5~2(average 1.2)mm. 84 cases were successfully implanted with success implant rate of 98%,2 cases with aortic right valve prolapse was retracted due to small to moderate aortic insuffiency. The mean selected diameter of the occluder was 8.4 mm ( ranged from 5~22 mm ). The left ventricular graphies(LVG) and ascending aortographies showed that 7 cases had a trace residual shunt and 5 cases associated with trace aortic insufficiency immediately after the procedures. All but one cases had no aortic insufficiency and no cases suffered with residual shunt at 3 month followup. One cases suffered with temporary advanced atrial ventricular block and returned to normal after medicines treatment. CONCLUSION Transcatheter closure of perimembranous VSDs associated with aortic rims (<2 mm) is feasible. Longterm followup data are still needed to assess longterm safety and efficacy.

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(4):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（5）：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（6）：518-520.

［4］ Gu X，Han YM，Titus JL，et al．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．

［5］ 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.

备注/Memo

备注/Memo:
收稿日期：2004-12-26.基金项目：陕西省自然科学基金资助(项目编号:2003C2053)
更新日期/Last Update: 2010-01-05