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目的探讨新型动脉导管未闭封堵器(Amplatzer duct occluderⅡ)行幼儿膜周部室间隔缺损(PMVSD)封堵的可行性。方法选取2例幼儿PMVSD病例,1例为3岁,心脏超声示膜部VSD,左室面缺损为5.5 mm,右室面分流口为2.3 mm,VSD上缘距主动脉瓣4 mm,另1例为2岁10个月,超声示膜部VSD,左室面缺损7.8 mm,分流口为2 mm,VSD上缘距主动脉瓣5.8 mm,均采用Duct Occluder II进行封堵。结果分别选择4 mm×4 mm Duct Occluder II,5 F输送长鞘;4 mm×3 mm封堵器,4 F长鞘,均按常规建立动静脉轨迹后分别释放左盘面和右盘面,按常规释放,术后心脏超声和造影显示VSD封堵部位无残余分流,无主动脉返流,1例出现右房室瓣轻度返流;术后2 d行心电图检查无异常。结论幼儿PMVSD可选择新型动脉导管未闭封堵器进行封堵,输送鞘小,对血管损伤小;术后近期无明显残余分流、无瓣膜反流和心律失常等并发症。
Objective To investigate the feasibility of a new type of ductal plug occluder (Amplatzer duct occluder Ⅱ) in children with perimembranous ventricular septal defect (PMVSD) closure. Methods Two cases of childhood PMVSD were selected. One case was 3 years old. The VSD of the cardiac ultrasound was 5.5 mm in the left ventricular surface defect and 2.3 mm in the right ventricular surface. The upper edge of the VSD was 4 mm from the aortic valve and the other 1 Cases of 2-year-old 10 months, Department of Ultrasound film VSD, left ventricular defect 7.8 mm, shunt 2 mm, VSD margin aortic valve 5.8 mm, were sealed with Duct Occluder II. Results The 4 mm × 4 mm Duct Occluder II and 5 F long sheaths, 4 mm × 3 mm occluders and 4 F sheaths were used to establish the arteriovenous trajectory. The left and right discs were released respectively according to the routine Release, postoperative cardiac ultrasound and angiography showed no residual shunt VSD occlusion sites, no aortic regurgitation, 1 case of right atrioventricular valve regurgitation mild; 2 d postoperative ECG was normal. Conclusions The new type of patent ductus arteriosus occluder can be choosed in young children with PMV closure. The delivery sheath is small and the vascular damage is small. No postoperative residual shunt, valvular regurgitation, arrhythmia and other complications are found.