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目的 评估膜部室间隔缺损 (室缺 )的导管封堵介入治疗的临床效果。方法 89例患者均有运动后心悸气短 ,胸骨左缘第 3~ 4肋间可闻及Ⅲ~Ⅳ级收缩期返流样杂音 ,肺动脉瓣区第二音增强或分裂。心电图显示左心室肥厚 17例 ,左心房增大 8例。超声心动图证实为膜部室缺。左心室造影测量室缺直径为 3~ 10 (4 .9± 1.8)mm ,室缺上缘距主动脉瓣下缘 1~ 5 (2 .3± 0 .9)mm ,36例合并有膜部室间隔膨出瘤 ,2例合并动脉导管未闭 (PDA)和 1例并轻度主动脉瓣关闭不全。选用Judkins右冠状动脉导管和Terumo导丝 ,通过室缺建立轨道 ,82例采用膜部室缺封堵器 6~ 14型号封堵 ,7例选用PDA蘑菇伞封堵 ,合并PDA者先行室缺封堵而后堵闭PDA。结果 88例介入治疗成功 ,6 7例即刻无分流 ,2 1例有少量分流 ,1例室缺术后封堵器脱落 ,经导管取出后行外科手术修复室缺 ,无其他严重并发症。随访 1~ 15个月无异常表现。结论 在严格选择适应证和有熟练操作技巧的条件下 ,膜部室缺封堵术是一项操作安全、疗效可靠的治疗方法 ,远期疗效尚需长期临床观察
Objective To evaluate the clinical effect of interventional catheterization for ventricular septal defect (ventricular septal defect). Methods Eighty-nine patients had shortness of breath after exercise, third to fourth intercostal space on the left margin of the sternum, and systolic murmur in systolic stage Ⅲ-Ⅳ, and enhanced or split second pulmonary tone in pulmonary valve area. Electrocardiogram showed left ventricular hypertrophy in 17 cases, left atrial enlargement in 8 cases. Echocardiography confirmed membranous ventricular septal defect. Left ventricular angiography measurement of vacancy diameter of 3 ~ 10 (4. 9 ± 1.8) mm, the upper margin of the aortic valve margin from the lower edge of the aortic valve 1 ~ 5 (2.3 ± 0.9mm), 36 patients with membranous chamber Intervals of bulging tumor, 2 cases with patent ductus arteriosus (PDA) and 1 case with mild aortic regurgitation. Select Judkins right coronary catheter and Terumo guide wire, through the ventricular septal orbit, 82 cases with membranous ventricular septal occluder 6 to 14 models of closure, 7 cases selected PDA mushroom umbrella blockage, combined with PDA first room closure plug Then plug the PDA. Results 88 cases were successful in interventional therapy, 67 cases had no shunt immediately, 21 cases had small shunt, 1 case had occlusion after shedding. After catheter removal, surgical repair of ventricular septal defect was performed without other serious complications. Follow-up 1 to 15 months without abnormal performance. Conclusion In the strict selection of indications and skilled operating conditions, the lack of closure of the membrane chamber is a safe and reliable curative treatment, the long-term efficacy still needs long-term clinical observation