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目的观察应用新型输送系统经胸微创封堵膜周部室间隔缺损(VSD)效果。方法11例膜周VSD患儿,年龄11月～12岁(中位年龄3.2岁),体重(15.8±6.4)kg,接受经胸微创非体外循环室间隔缺损封堵术。根据经食道超声心动图(TEE)选择合适的封堵器类型,然后自胸骨下端3～5 cm小切口入胸,TEE引导和实时监测下穿刺右心室前壁,建立轨道,释放封堵器关闭VSD。TEE评估封堵器的位置、对主动脉瓣、房室瓣的影响以及有无残存分流。结果11例患儿均1次封堵成功,超声引导下释放封堵器的时间为5～12 min,无残余分流和主动脉瓣反流,心电监测无明显心律失常。术后3～5 d出院,随访5个月以上无残余分流、主动脉瓣反流以及周围组织卡压。结论应用新型输送系统经胸微创非体外循环下置入室间隔缺损封堵器是一种安全、有效的治疗方法,有较大临床推广价值。
Objective To observe the effect of transthoracic minimally invasive transseptal ventricular septal defect (VSD) using a novel delivery system. Methods A total of 11 children with VSD were included, ranging in age from 11 months to 12 years old (median age 3.2 years) and weighing (15.8 ± 6.4) kg. The patients underwent minimally invasive transthoracic echocardiography with ventricular septal defect closure. According to the transesophageal echocardiography (TEE), select the appropriate type of occluder, and then from the bottom of the sternum 3 ~ 5 cm small incision into the chest, TEE guidance and real-time monitoring puncture the anterior wall of the right ventricle, orbit, release occluder closed VSD. TEE assess the location of the occluder, the aortic valve, atrioventricular valve effects and the presence of residual shunt. Results All the 11 cases were successfully occluded once. The time of releasing the occluder under the guidance of ultrasound was 5 to 12 minutes without residual shunt and aortic valve regurgitation. There was no significant arrhythmia in ECG monitoring. The patients were discharged from 3 to 5 days after operation. No residual shunts, aortic regurgitation and compression of surrounding tissues were observed after more than 5 months of follow-up. Conclusion The application of a novel delivery system for transcatheter closure of ventricular septal defect using transthoracic minimally invasive non-cardiopulmonary bypass is a safe and effective treatment and has great clinical value.