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目的:探讨封堵器置入时保留导丝的方法封堵室间隔缺损(VSD)的临床疗效及安全性。方法:根据经胸超声心动图(TTE)选择符合介入治疗条件的32例VSD患者,常规建立股静脉→右心室→VSD→左心室→股动脉导丝轨道,输送长鞘沿导丝轨道从右室侧通过VSD进入左心室心尖部,此时,不按常规方法撤出导丝轨道,而是在保留导丝轨道的情况下将封堵器沿输送长鞘送至病变处打开,然后行TTE检查,如封堵效果不满意,则收回封堵器,按上述方法沿保留的导丝轨道更换封堵器,直至封堵效果满意再撤出导丝,左心室造影(LVG)确认封堵成功后释放封堵器。结果:32例患者全部封堵成功。1次封堵成功20例,再次更换封堵器封堵成功12例。左心室造影VSD直径为6～16(9±3.5)mm,封堵器为7～18(10±3.8)mm。所有患者术后即刻心脏杂音消失、TTE及LVG检查确认封堵成功。操作时间25～70(46±10)min,X线透视时间7.2～21(11.6±3.8)min。术后3d、1个月及6个月分别行TTE、心电图、X线检查,全部患者无残余分流,封堵器位置固定良好,无严重并发症发生。结论:封堵器置入时保留导丝的方法封堵VSD安全、高效,特别适用于难度较大的VSD封堵,该方法简化了更换封堵器时需重建导丝轨道的程序,缩短了操作及透视时间,减少了并发症的发生,手术成功率高,疗效可靠,值得推广。
Objective: To investigate the clinical curative effect and safety of occluder ventricular septal defect (VSD) by means of retaining guidewire when occluder implantation. Methods: According to transthoracic echocardiography (TTE), 32 patients with VSD who underwent interventional therapy were selected to establish femoral vein → right ventricle → VSD → left ventricle → femoral artery guidewire path, Ventricular side through the VSD into the apex of the left ventricle, this time, do not withdraw the guide wire track conventional method, but keep the guide wire track under the occluder along the delivery of long sheath to the lesion opened, and then TTE If the occlusion effect is not satisfied, the occluder is withdrawn and the occluder is replaced along the reserved guidewire track as described above until the occlusion effect is satisfied and the guidewire is withdrawn. The left ventricular angiography (LVG) confirms the successful occlusion After the release of the occluder. Results: All 32 patients were successfully blocked. Successive occlusion in 20 cases, once again replace occluder occlusion in 12 cases. Left ventricular angiography VSD diameter of 6 to 16 (9 ± 3.5) mm, occluder 7 to 18 (10 ± 3.8) mm. All patients disappeared immediately after the heart murmur, TTE and LVG examination confirmed the successful closure. The operation time was 25-70 (46 ± 10) min and the X-ray fluoroscopy time was 7.2-21 (11.6 ± 3.8) min. TTE, electrocardiogram and X-ray were performed on the 3rd, 6th and 6th month after operation. All patients had no residual shunt, and the position of occluder was well fixed without serious complications. CONCLUSIONS: The method of retaining the guidewire when the occluder is inserted is safe and effective, and is especially suitable for the more difficult VSD occlusion. This method simplifies the procedure of reconstructing the guidewire track when replacing the occluder and shortens Operation and perspective of time, reducing the incidence of complications, high success rate of surgery, efficacy and reliable, it is worth promoting.