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目的总结我们通过微创经心室采用国产同心伞片行膜部室间隔缺损封堵的临床经验,探讨这项技术的手术方法和适应证。方法回顾性分析2011年12月至2012年7月上海交通大学医学院附属上海儿童医学中心45例膜部室间隔缺损患者[男25例,女20例;年龄(34.1±24.2)个月;体重(12.4±9.2)kg]采用胸下小切口经心室途径封堵治疗,患者均为膜周限制性室间隔缺损,室间隔缺损基底部直径2～9mm,缺损上缘距主动脉右冠瓣≥2mm,所选伞腰直径4～10mm。在经食管超声心动图的引导下非体外循环下经右心室放入室间隔封堵伞。结果术后发生室性早搏1例,经治疗好转并未复发。其余患者术后心功能稳定,随访1～6个月,患儿伞片位置无移位,无心律失常和残余分流。结论经胸小切口采用同心伞片封堵膜部室间隔缺损安全有效,但对于初学者应该严格把握手术适应证。
Objective To summarize the clinical experience of occlusion of ventricular septal defect using minimally invasive ventricular cardiomyopathy with ventricular concentric umbrella in order to discuss the surgical methods and indications for this technique. Methods Forty-five patients with membranous ventricular septal defect at the Shanghai Children’s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine from December 2011 to July 2012 were retrospectively analyzed. They were 25 males and 20 females with a mean age of (34.1 ± 24.2) months. Body weight 12.4 ± 9.2) kg] were treated with transcatheter closure by transcatheter closure. All patients were limited peritoneal membrane ventricular septal defect. The basal diameter of ventricular septal defect ranged from 2 to 9 mm. The upper margin of defect was ≥2 mm The selected diameter of the umbrella waist 4 ~ 10mm. Under the guidance of transesophageal echocardiography under cardiopulmonary bypass into the right ventricle into the ventricular septal blocking umbrella. Results Postoperative ventricular premature beats in 1 case, after treatment did not relapse. The remaining patients with stable cardiac function, follow-up of 1 to 6 months, children with no shift position parachute, no arrhythmia and residual shunt. Conclusions Transcatheter closure of ventricular septal defect with concentric paraxial strip is safe and effective. However, for beginners, surgical indications should be strictly controlled.