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目的 :观察应用 Amplatzer偏心性封堵器经导管介入治疗先天性膜部室间隔缺损 (PMVSD)的远期疗效。 方法 :2 5例患者术前由经胸超声心动图 (TTE)确诊 PMVSD,术中经左心室造影明确缺损直径为 3～ 15 (6 .5 6± 2 .78) mm ;在透视及经胸超声心动图监视下经导管置入 Am platzer偏心性封堵器封堵 PMVSD;术后 3d、3个月、6个月及 1年分别行经胸超声心动图、心电图和 X线检查 ,评价治疗效果。结果:全组技术成功率为 10 0 % ,术中未发生任何严重并发症。除 1例外其他封堵器在随访中位置良好 ,3个月、6个月、1年随访时 TTE测左室舒张末期内径明显缩小 (P <0 .0 5 )。心电图检查术后 12 h内除 1例发生完全性左束支传导阻滞 ,没有严重心律失常发生 ;3个月随访时 3例 (14 .2 % )心电图新出现束支传导阻滞。术后 3d X线胸片提示肺充血有不同程度减轻 ,3个月、6个月、1年时胸片示心胸比例缩小 (P <0 .0 5 )。结论 :经导管置入 Amplatzer偏心性封堵器治疗 PMVSD是一种成功率高、并发症轻、远期疗效可靠的介入方法。
Objective: To observe the long-term efficacy of catheterized Amplatzer occluder for the treatment of congenital membranous ventricular septal defect (PMVSD). Methods: Twenty-five patients underwent preoperative transthoracic echocardiography (TTE) to diagnose PMVSD. The diameter of the defect was 3-15 (6.66 ± 2.78) mm by left ventricular angiography during operation. The echocardiographic monitoring was performed with am platzer eccentric occluder to block the PMVSD. The transthoracic echocardiogram, electrocardiogram and X-ray were performed at 3d, 3, 6 and 1 year after operation to evaluate the therapeutic effect . Results: The technical success rate of the whole group was 100%. No serious complications occurred during the operation. All but one occlusion device was well followed up, and left ventricular end-diastolic diameter was significantly reduced by TTE at 3 months, 6 months and 1 year follow-up (P <0. 05). There was no serious arrhythmia except one case of complete left bundle branch block within 12 hours after electrocardiogram examination. Three cases (14.2%) had new bundle branch block at 3 months follow-up. The postoperative radiographs of X-ray showed that pulmonary congestion was relieved to varying degrees. The chest radiographs decreased at 3 months, 6 months and 1 year (P <0.05). Conclusion: Transcatheter Amplatzer eccentric occluder for the treatment of PMVSD is a successful intervention method with high success rate, light complications and long-term curative effect.