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目的探讨影响儿童室间隔缺损(VSD)自然闭合的因素。方法于1993-01—2006-01采用彩色二维多普勒超声心动图仪或实时三维心脏彩色多普勒超声仪对潍坊市人民医院儿科诊治的372例单纯VSD患儿进行多切面观察,充分显示VSD部位、游离缘,测量缺损大小、穿隔血流宽度、肺动脉收缩压(Pp)和双室内径等,并查X线胸片及体检。每3～6个月随访1次,最长随访时间8年。结果75例VSD自然闭合,确诊年龄(11.7±5.1)个月,闭合年龄(26.2±11.6)个月。6个月至3岁组闭合率最高(72.0%),后依次为<6个月组(13.3%),～6岁组(12.1%),～7岁组(2.7%);闭合组62例收缩期杂音消失,13例变为Ⅰ或Ⅱ级局限的收缩期杂音;闭合组均为小中型VSD,大型VSD无一例闭合,两组差异有显著性(P<0.01)。闭合组和未闭合组VSD直径分别为(8.7±3.6)mm、(13.7±4.8)mm,差异有统计学意义(P<0.01);单发VSD闭合率高于多发VSD(P<0.01);膜周部VSD闭合62例,肌部VSD闭合13例,干下型无闭合病例,差异有显著性意义(P<0.01)。肌部VSD闭合率高于膜周部(P<0.01);超声心动图(UCG)显示VSD游离缘不规整回声弱者闭合率显著高于游离缘规整回声强者(P<0.01);闭合组和未闭合组Pp分别为(27.2±11.7)mmHg(1mmHg=0.133kPa)、(39.2±12.6)mmHg,差异有统计学意义。Pp越高,自然闭合率越低,>50mmHg无闭合病例;闭合组左室舒张末径(LVEDD)、右室舒张末径(RVEDD)、心胸比率(C/T值)显著低于未闭合组(P均<0.01)。结论VSD患儿年龄,缺损大小、类型、数目、形态,Pp,心室大小是影响VSD自然闭合的因素。VSD游离缘回声弱且不规整形态可作为缺损有自然闭合趋势的重要标志。Pp监测对判定漏诊的多发VSD有一定价值。
Objective To explore the factors affecting the natural closure of children with ventricular septal defect (VSD). Methods A total of 372 simple VSD children with pediatric diagnosis and treatment in Weifang People ’s Hospital were observed by multi - slice color Doppler echocardiography or real - time three - dimensional color Doppler sonography from 1993-01-2006-01. Show the VSD site, free edge, measuring the size of the defect, across the blood flow width, pulmonary artery systolic blood pressure (Pp) and double-chamber diameter, and check X-ray and physical examination. Every 3 to 6 months follow-up 1, the longest follow-up time of 8 years. Results 75 cases of VSD closed naturally, the confirmed age was (11.7 ± 5.1) months and the closure age (26.2 ± 11.6) months. The closure rates ranged from 6 months to 3 years (72.0%), followed by 6 months (13.3%), 6 years (12.1%) and 7 years (2.7%), followed by 62 cases Systolic murmur disappeared, 13 cases turned to Ⅰ or Ⅱ level systolic murmur. The closed group were both small and medium VSD, but none of the large VSD was closed. There was significant difference between the two groups (P <0.01). The VSD diameters of the closed and unclosed groups were (8.7 ± 3.6) mm and (13.7 ± 4.8) mm, respectively, with significant difference (P <0.01). The closed rate of single VSD was higher than that of multiple VSD (P <0.01). There were 62 cases of VSD closure, 13 cases of closed VSD of muscular part, and no significant difference between the two groups (P <0.01). The closed rate of VSD was higher in the muscular part than that in the peripheral part of the membrane (P <0.01). The echocardiography (UCG) showed that the closing rate of weak echo with irregular edge of VSD was significantly higher than that of the free edge regular echo (P <0.01) The Pp of the unclosed group were (27.2 ± 11.7) mmHg (1mmHg = 0.133kPa) and (39.2 ± 12.6) mmHg, respectively, with significant difference. The higher the Pp, the lower the natural occlusion rate was, and no occlusion> 50mmHg. The LVEDD, RVEDD and C / T ratio in the closed group were significantly lower than those in the non-closed group (P <0.01). Conclusion The age, defect size, type, number, shape, Pp and ventricular size of children with VSD are the factors affecting the natural closure of VSD. VSD free edge echo weak and irregular shape defect as a natural closure of the important signs. Pp monitoring to determine the missed diagnosis of multiple VSD have some value.