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目的应用国产对称双盘状封堵器经导管治疗小儿室间隔缺损(VSD)并对其疗效进行初步评价。方法全组446例,其中443例为膜部VSD,3例为肌部室VSD,年龄7±8(2～12)岁。VSD左室面直径为6.8±3.9(2.0～12.0)mm。经6F～10F传送鞘置入对称双盘状封堵器,封堵后即刻行左心室造影,术后1d、1个月、6个月及行超声心动图检查观察有无残余分流。结果全组446例封堵器植入成功,植入技术成功率100%。术后即刻左心室造影示81例(18.2%)存在微～少量残余分流,365例(81.8%)封堵完全无残余分流。术后24～48h超声心动图示分流完全消失410例(91.9%)、微～少量残余分流36例(8.1%)。1例封堵术后24h发生溶血,经过7d内科保守治疗治愈。8例封堵术后3d发生一过性Ⅲ度房室传导阻滞,经过4～10d内科保守治疗治愈。1个月超声心动图发现2例残余分流(0.9%)。结论应用国产双盘状封堵器治疗小儿室间隔缺损是一种安全有效的介入方法,操作简便,成功率高,近期疗效可靠,中远期疗效尚需进一步观察。
Objective To treat pediatric ventricular septal defect (VSD) with catheter by using a domestic symmetrical double disc occluder and evaluate its efficacy. Methods 446 cases of the whole group, of which 443 cases of membranous VSD, 3 cases of muscular ventricular VSD, age 7 ± 8 (2 ~ 12) years old. VSD left ventricular diameter of 6.8 ± 3.9 (2.0 ~ 12.0) mm. The 6F ~ 10F transmission sheath into the symmetrical double disc occluder, immediately after the closure of the left ventricular angiography, 1d, 1 month, 6 months and line echocardiography to check for residual shunt. Results The whole group of 446 occluders were implanted successfully and the success rate of implantation was 100%. Immediate postoperative left ventricular angiography showed that there were 81 cases (18.2%) with slight to residual residual shunt and 365 cases (81.8%) with complete residual shunt. Echocardiography at 24-48 hours postoperatively showed complete disappearance of 410 cases (91.9%), with a slight residual residual shunt in 36 cases (8.1%). One case of occlusion after hemolysis occured 24h, after 7d of conservative treatment of internal medicine cure. Eight cases of occlusion occurred after a third degree of atrioventricular block, after 4 ~ 10d conservative treatment of internal medicine cure. One-month echocardiography revealed 2 residual shunts (0.9%). Conclusion The application of domestic double disc occluder in the treatment of children with ventricular septal defect is a safe and effective interventional method, easy to operate, high success rate, the recent curative effect is reliable, the long-term efficacy needs further observation.
