CAJ | 학술논문

目的：探讨经导管介入治疗婴幼儿先天性心脏病室间隔缺损的可行性及远期疗效。方法研究总结海南省人民医院心内科2002年12月至2013年10月间经导管介入治疗的173例婴幼儿先天性室间隔缺损的临床资料。结果患儿年龄11个月～3岁[（2.1±0.7）岁]，其中男81例，女92例，体重6～15 kg[（10.2±3.6）kg]；室间隔缺损直径2.5～9.0 mm[（5.1±1.7）mm]，其中单纯膜周部缺损88例（50.9%），膜周部缺损并膜部瘤形成52例（30.1%），膜周部缺损并主动脉瓣脱垂13例（7.5%），嵴内型室间隔缺损20例（11.6%），置入封堵器直径4～12 mm[（6.3±2.2）mm]。随访1个月～10年[（6.2±1.3）年]。173例患者中168例成功封堵，成功率97.1%，未成功的5例患者中，3例封堵器置入后出现中度主动脉瓣反流，2例导管通过缺损即多次出现完全性房室传导阻滞（CAVB）。随访过程中，1例患儿术后第3天发生CAVB，经地塞米松治疗4 d后恢复。3例患儿在术后即刻出现完全性左束支传导阻滞，随访中仅1例患儿发展为持续性完全性左束支传导阻滞，该患儿随访的5年中未发现心功能异常，1例患儿在随访的第4年发现完全性左束支传导阻滞，之后随访的3年中未发现心功能异常。术后第1天复查心脏彩超发现4例新发的主动脉瓣轻度反流和8例残余分流（宽约1～2 mm），发现主动脉瓣轻度反流患儿在分别随访的6个月、2年、3.5年和8.5年中未发现进行性加重，发现残余分流患儿有4例在1个月后恢复，3例在6个月后恢复，1例在1年后恢复。随访的1个月～10年间无溶血、封堵器移位或脱落、迟发性房室传导阻滞等并发症。结论经导管介入治疗婴幼儿室间隔缺损是一项安全可行的技术，远期疗效良好。
목적：탐토경도관개입치료영유인선천성심장병실간격결손적가행성급원기료효。방법연구총결해남성인민의원심내과2002년12월지2013년10월간경도관개입치료적173례영유인선천성실간격결손적림상자료。결과환인년령11개월～3세[（2.1±0.7）세]，기중남81례，녀92례，체중6～15 kg[（10.2±3.6）kg]；실간격결손직경2.5～9.0 mm[（5.1±1.7）mm]，기중단순막주부결손88례（50.9%），막주부결손병막부류형성52례（30.1%），막주부결손병주동맥판탈수13례（7.5%），척내형실간격결손20례（11.6%），치입봉도기직경4～12 mm[（6.3±2.2）mm]。수방1개월～10년[（6.2±1.3）년]。173례환자중168례성공봉도，성공솔97.1%，미성공적5례환자중，3례봉도기치입후출현중도주동맥판반류，2례도관통과결손즉다차출현완전성방실전도조체（CAVB）。수방과정중，1례환인술후제3천발생CAVB，경지새미송치료4 d후회복。3례환인재술후즉각출현완전성좌속지전도조체，수방중부1례환인발전위지속성완전성좌속지전도조체，해환인수방적5년중미발현심공능이상，1례환인재수방적제4년발현완전성좌속지전도조체，지후수방적3년중미발현심공능이상。술후제1천복사심장채초발현4례신발적주동맥판경도반류화8례잔여분류（관약1～2 mm），발현주동맥판경도반류환인재분별수방적6개월、2년、3.5년화8.5년중미발현진행성가중，발현잔여분류환인유4례재1개월후회복，3례재6개월후회복，1례재1년후회복。수방적1개월～10년간무용혈、봉도기이위혹탈락、지발성방실전도조체등병발증。결론경도관개입치료영유인실간격결손시일항안전가행적기술，원기료효량호。
Objective To study the feasibility and long-term effects in 173 infants with congenital ventricular septal defect who underwent transcatheter therapy by double-disk ventricular septal defect occluder. Methods We analyzed the clinical data of 173 infants with ventricular septal defect who were performed interventional therapy followed by a follow up study from December 2002 to October 2013. Results The procedure was performed in 173 infants (male = 81 cases and female = 92 cases) aged 11 month-3 years[(2.1±0.7)years]. The weight were 6-15 kg[(10.2±3.6)kg]. The diameter of the defects ranged from 2.5-9.0 mm[(5.1±1.7) mm]. The characteristics of septal were classiifed into four types:the simply perimembranous ventricular septal defects (88 patient,50.8%), the perimembranous ventricular septal defects with pseudoaneurysm (52 patients, 30.0%), the perimembranous ventricular septal defects complicated with aortic valve prolapse (13 patients, 7.5%), and the intracristal ventricular septal defect (20 patients, 11.7%). The diameter of the occluders were between 4-12 mm[(6.3±2.2)mm]. The period of follow-up ranged from 1 month-10 years[(6.2±1.3)years]. The 168 defects were completely occluded in 173 patients(97.1%closure rate) except 5 infants, which 3 patients because the occluder hinder the function of aortic valves and the other occurred complete atrioventricular block(CAVB) when the catheter through defect. One patient occurred CAVB on the third day after the procedure, was reversed by dexamethasone after 4 days. 3 patients with complete left bundle branch block(CLBBB) after the procedure and one went to sustained, but did not observed heart failure in this case during 5 years follow-up. One patient observed sustained CLBBB on the fourth year after the procedure, also did not observed heart failure in this case during 3 years follow-up. 8 patients with trivial residual shun and 4 patients with newly appearance of trivial aortic regurgitation after the procedure, the shun all disappear at one year and the regurgitation did not progress during longest follow-up period at 8.5 years. No other complications, including late-onset CAVB, hematolysis, the occluder displacement and detachment, occurred during 1 month-10 years of follow-up. Conclusions Transcatheter closure of congenital ventricular septal defects is an efifcient method that can be safely used in the majority of infants with ventricular septal defects and have signiifcant long-term effects.