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目的:探讨嵴内型室间隔缺损介入治疗适应证选择,并评价其近期疗效。方法:2004年3月至2005年11月,采用国产新型零偏心室间隔缺损(VSD)封堵器对49例嵴内型VSD患者进行封堵治疗,其中男25例,女24例,年龄2．5～15(6．2±3．6)岁。经胸超声心动图显示VSD的直径2～10(5．2±2．3)mm。所有患者在透视及超声监测下通过建立股动静脉轨道,经右心系统释放封堵器,并分别于术后1、3、6、12个月通过经胸超声心动图检查、12导联心电图检查等,从残余分流、瓣膜功能、心功能、心电图及封堵器直径变化率5方面进行随访评价。结果:45例患者封堵器置入成功,技术成功率91．8％。4例未成功者分别为:3例为伴有主动脉瓣脱垂者,1例为超声判断误差。42例患者接受了1～12(平均8．6)个月的随访,所有随访病例中,无新增加的三尖瓣关闭不全,无主动脉瓣穿孔,2例出现少量主动脉瓣反流者,其中1例为封堵器出现微移位。无其他严重并发症发生。封堵器置入即刻及术后6个月,左心室舒张末径发生进行性缩小,而右心室舒张末前后径及射血分数未见明显变化。封堵器置入24 h,封堵器腰部直径较置入即刻发生轻微变化,术后1、3、6、12个月随访无明显变化。结论:缺损直径在10 mm以内且无病理性主动脉反流的嵴内型VSD可以选择介入治疗,其近期效果良好。
Objective: To investigate the choice of indications for interventional treatment of intracristal ventricular septal defect and to evaluate its short-term curative effect. Methods: From March 2004 to November 2005, 49 patients with intracristal VSD were occluded with a new home-made eccentric occlusion of ventricular septal defect (VSD), including 25 males and 24 females, and a mean age of 2 .5 ~ 15 (6.2 ± 3.6) years old. Transthoracic echocardiography showed a VSD diameter of 2 to 10 (5.2 ± 2.3) mm. All patients underwent fluoroscopy and ultrasound monitoring through the establishment of femoral venous orbit, the release of the occluder via the right heart, and respectively at 1,3,6,12 months after transthoracic echocardiography, 12-lead electrocardiogram Examination, etc., from the residual shunt, valve function, cardiac function, ECG and occluder diameter change rate of 5 aspects of follow-up evaluation. Results: 45 cases of occluder implantation success, the technical success rate of 91.8%. Four cases of unsuccessful patients were: 3 cases were associated with aortic valve prolapse, 1 case of ultrasound to determine the error. Forty-two patients underwent 1-12 (mean 8.6) months of follow-up. In all follow-up cases, no new tricuspid regurgitation, no aortic valve perforation, and 2 minor aortic regurgitation One of the occluders showed micro-displacement. No other serious complications occurred. Immediate occlusion and 6 months after occlusion occured, the left ventricular end-diastolic diameter decreased progressively, while the right ventricular diastolic anteroposterior diameter and ejection fraction had no significant changes. After occluder implantation for 24 h, the diameter of occluder waist slightly changed immediately, and no significant changes were observed at 1, 3, 6 and 12 months after operation. CONCLUSION: Intervertebral disc-shaped VSD with defect diameter less than 10 mm and no pathological aortic regurgitation can be selected as interventional therapy. The short-term effect is good.