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目的 探讨新型Amplatzer室间隔缺损封堵器治疗膜周部及肌部室间隔缺损 (VSD)的疗效和对心脏传导系统的影响。方法 2 0 0 3- 0 7～ 2 0 0 4 - 0 4采用新型Amplatzer膜部及肌部VSD封堵器对 12例膜周部VSD和 2例肌部VSD患者进行封堵治疗。对心脏多普勒超声检查符合导管封堵条件病人术前常规进行心导管检查 ,测定血流动力学各项参数。在X线透视、食管或经胸超声的监测下建立股动静脉轨道 ,经右心系统释放封堵器。对 12例膜周部VSD病人在手术前、后进行心内电生理检查 ,测定房室传导时间 (AV间期 )和房室结不应期 ,观察封堵手术对心脏传导系统的影响。病人分别于术后 2周、1个月、3个月、6个月进行随访。结果 14例患者 (男 8例 ,女 6例 )封堵器置入全部成功。术后即刻超声及造影均示完全封堵 12例 ,微量残余分流 2例 ,均在 1d内消失 ,总完全封堵率为 10 0 %。 12例膜周部VSD病人封堵后即刻AV间期有不同程度的延长 ,其中 3例术后AV间期 >2 0 0ms,1周后心电图检查 2例PR间期恢复正常。封堵前后房室结不应期无明显变化。未出现Ⅱ度以上房室传导阻滞和束支传导阻滞 ,无心肌受损表现 ,无其它严重并发症发生。结论 应用新型Amplatzer膜部和肌部VSD封堵器治疗膜周部和肌部VSD是安全有效的 ,近期效果良好 ,是导
Objective To investigate the efficacy and safety of the new Amplatzer ventricular septal defect occluder in the treatment of ventricular septal and muscular ventricular septal defects (VSD). Methods 2 0 0 3- 0 7 ~ 2 0 0 4 - 0 4 A total of 12 patients with VSD and 2 patients with VSD were treated with Amplatzer diaphragm and muscular VSD occluder. Cardiac Doppler ultrasound examination of catheter occlusion conditions consistent with preoperative routine catheterization, determination of hemodynamic parameters. In the X-ray, esophageal or transthoracic ultrasound to establish the femoral vein track, release of the occluder via the right heart system. Echocardiography was performed in 12 patients with perimembranous VSD before and after surgery, and the atrioventricular conduction time (AV interval) and atrioventricular node refractory period were determined. The effect of occlusion on cardiac conduction system was observed. Patients were followed up for 2 weeks, 1 month, 3 months and 6 months respectively. Results 14 patients (8 males and 6 females) occluders were all inserted successfully. Immediate ultrasound and angiography showed complete occlusion in 12 cases, trace residual shunt in 2 cases, disappeared within 1d, the total complete occlusion rate was 100%. In 12 patients with VSD, the AV interval was prolonged to some extent immediately after occlusion. Among them, 3 patients had> 2 0 ms AV interval after operation, and 2 cases returned to normal after 2 weeks. Before and after closure of atrioventricular node should not change significantly. No grade Ⅱ or more atrioventricular block and bundle branch block were found, no myocardial damage was found, and no other serious complications occurred. Conclusion The application of the new Amplatzer membranous and muscular VSD occluder is safe and effective in the treatment of peri-and posterolateral VSDs and has recently achieved good results.