中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2010年
4期
321-325
,共5页
刘璟%游晓华%赵仙先%胡健强%曹江%徐荣良%吴弘%陈少萍%章建梁%郑兴%秦永文
劉璟%遊曉華%趙仙先%鬍健彊%曹江%徐榮良%吳弘%陳少萍%章建樑%鄭興%秦永文
류경%유효화%조선선%호건강%조강%서영량%오홍%진소평%장건량%정흥%진영문
室间隔缺损%心脏导管插入术%封堵器
室間隔缺損%心髒導管插入術%封堵器
실간격결손%심장도관삽입술%봉도기
Ventricular septal defect%Heart catheterization%Occluder device
目的 评价应用国产封堵器治疗先天性膜周部室间隔缺损(pmVSD)的近期疗效和安全性.方法 选择2001年12月至2008年12月在上海长海医院心内科使用国产封堵器治疗的pmVSD患者604例.所有患者术后1周每天观察临床症状并行12导联心电图检查,术后3～7 d复查经胸超声心动图(TTE)和X线胸片.结果 604例患者中封堵成功576例,共置入封堵器583枚,放弃封堵28例,手术成功率95.4%.无感染性心内膜炎、血栓栓塞、猝死等并发症发生.81例患者术后出现不同类型的传导阻滞,其中右束支传导阻滞56例,左束支传导阻滞14例.31例患者在术后出现一过性的加速性室性自主心律.完全性房室传导阻滞(cAVB)11例,9例在3周内恢复,2例安置永久性心脏起搏器,其中1例术前有一过性cAVB,另1例为同时封堵房间隔缺损并室间隔缺损的患者.术后即刻,69例(12.0%)有微量-少量残余分流,术后7 d,31例分流完全消失,仍有38例(6.6%)存在微量-少量残余分流.术后主动脉瓣反流加重5例,2例由术前的微量加重到术后少量反流,3例由少量加重到中量;术后出现三尖瓣微-少量反流32例,中量反流3例.5例机械性溶血,其中1例持续5 d无好转,经导管取出封堵器,其余4例均在术后3～14 d恢复正常.1例术后出现股动脉假性动脉瘤,经加压包扎后消失.封堵器脱落1例,经导管取出,并成功行封堵治疗.封堵器移位1例,在原位置入另一封堵器.结论 使用国产封堵器治疗室间隔缺损成功率高,并发症少,是一种安全有效的治疗方法.
目的 評價應用國產封堵器治療先天性膜週部室間隔缺損(pmVSD)的近期療效和安全性.方法 選擇2001年12月至2008年12月在上海長海醫院心內科使用國產封堵器治療的pmVSD患者604例.所有患者術後1週每天觀察臨床癥狀併行12導聯心電圖檢查,術後3～7 d複查經胸超聲心動圖(TTE)和X線胸片.結果 604例患者中封堵成功576例,共置入封堵器583枚,放棄封堵28例,手術成功率95.4%.無感染性心內膜炎、血栓栓塞、猝死等併髮癥髮生.81例患者術後齣現不同類型的傳導阻滯,其中右束支傳導阻滯56例,左束支傳導阻滯14例.31例患者在術後齣現一過性的加速性室性自主心律.完全性房室傳導阻滯(cAVB)11例,9例在3週內恢複,2例安置永久性心髒起搏器,其中1例術前有一過性cAVB,另1例為同時封堵房間隔缺損併室間隔缺損的患者.術後即刻,69例(12.0%)有微量-少量殘餘分流,術後7 d,31例分流完全消失,仍有38例(6.6%)存在微量-少量殘餘分流.術後主動脈瓣反流加重5例,2例由術前的微量加重到術後少量反流,3例由少量加重到中量;術後齣現三尖瓣微-少量反流32例,中量反流3例.5例機械性溶血,其中1例持續5 d無好轉,經導管取齣封堵器,其餘4例均在術後3～14 d恢複正常.1例術後齣現股動脈假性動脈瘤,經加壓包扎後消失.封堵器脫落1例,經導管取齣,併成功行封堵治療.封堵器移位1例,在原位置入另一封堵器.結論 使用國產封堵器治療室間隔缺損成功率高,併髮癥少,是一種安全有效的治療方法.
목적 평개응용국산봉도기치료선천성막주부실간격결손(pmVSD)적근기료효화안전성.방법 선택2001년12월지2008년12월재상해장해의원심내과사용국산봉도기치료적pmVSD환자604례.소유환자술후1주매천관찰림상증상병행12도련심전도검사,술후3～7 d복사경흉초성심동도(TTE)화X선흉편.결과 604례환자중봉도성공576례,공치입봉도기583매,방기봉도28례,수술성공솔95.4%.무감염성심내막염、혈전전새、졸사등병발증발생.81례환자술후출현불동류형적전도조체,기중우속지전도조체56례,좌속지전도조체14례.31례환자재술후출현일과성적가속성실성자주심률.완전성방실전도조체(cAVB)11례,9례재3주내회복,2례안치영구성심장기박기,기중1례술전유일과성cAVB,령1례위동시봉도방간격결손병실간격결손적환자.술후즉각,69례(12.0%)유미량-소량잔여분류,술후7 d,31례분류완전소실,잉유38례(6.6%)존재미량-소량잔여분류.술후주동맥판반류가중5례,2례유술전적미량가중도술후소량반류,3례유소량가중도중량;술후출현삼첨판미-소량반류32례,중량반류3례.5례궤계성용혈,기중1례지속5 d무호전,경도관취출봉도기,기여4례균재술후3～14 d회복정상.1례술후출현고동맥가성동맥류,경가압포찰후소실.봉도기탈락1례,경도관취출,병성공행봉도치료.봉도기이위1례,재원위치입령일봉도기.결론 사용국산봉도기치료실간격결손성공솔고,병발증소,시일충안전유효적치료방법.
Objective To evaluate the efficacy and adverse effects of transcatheter closure of perimembranous ventricular septal defect (pmVSD) with modified double-disk occluder device (MDVO).Methods Clinical data including clinical examination,electrocardiography daily after the procedure for a week,chest-X-rays and TIE before discharge and at 3-5 days after the procedure were analyzed from 604 patients underwent percutaneous closure of a pmVSD with MDVO at our department between December 2001 and December 2008.Results Procedure was successful in 576 out of 604 patients (95.4%) and 583 VSD occtuders were placed.Endocarditis,thromboembolism,or deaths were not observed after procedure.Conduction block occurred in 81 patients (56 RBBB,14 LBBB) and transient nonparoxysmal ventricular tachyeardia in 31 patients after the procedure.Complete heart block occurred in 11 patients,9 of them recovered in 3 weeks,permanent pacemaker was implanted in 2 patients (one had transient Ⅲ°AVB before the procedure,the other underwent simultaneous closure of ventricular septal defect and atrial septal defect).Trivial/small residual shunts were found in 69 patients(12.0%).The residual shunts disappeared in 31 patients and remained unchanged in 38 patients (6.6%) 7 days after procedures.Aortic regurgitation developed in 5 patients (2 trivial/small,3 small/moderate),and tricuspid regurgitation was present in 35 patients (32 trivial/small,3 moderate).Five patients developed haemolysis (device retrieved via catheter in 1 patient due to persistent haemolysis,the other 4 patients recovered 3-14 days post procedure) .Pseudoaneurysm of femoral artery occurred in 1 patient,and disappeared by pressure dressing.Device was successfully replaced in 2 patients with either device embolization (n = 1) or device misplacement (n = 1)after device retrieval by catheter.Conclusion It is safe and effective to close congenital perimembranous ventricular septal defect with domestic-made occluder device.
