CAJ | 학술논문

目的评价动脉导管末闭封堵器(PDA封堵器)治疗嵴内型室间隔缺损(IVSD)的临床疗效.方法 2012年7月至2013年9月经皮PDA封堵器介入治疗IVSD 27例,在术前、术后24 h,术后1、3、6、12个月行超声心动图、心电图、体格检查,与同期使用偏心型室间隔缺损封堵器(偏心型封堵器)介入治疗IVSD 53例进行对比研究.结果 PDA封堵器成功植入26例、偏心型封堵器成功植入42例,2组手术成功率分别为96.23％、79.25％,平均随访时间为6.78个月(1～ 17个月),2组手术时间、曝光时间、残余分流方面差异无统计学意义,PDA封堵器组缺损直径(t=-3.124,P=0.003)、封堵器直径(t=-4.285,P＜0.001)较偏心型封堵器组小,手术成功率较偏心型封堵器组高(x2 =9.099,P=0.011).与术前相比,除右心房内径、左心室射血分数无统计学差异外,左心室舒张末期内径、左心房内径、右心室舒张末期内径、主肺动脉内径术后均显著缩小(F =57.62、5.002、4.754、2.782,P=0.000、0.033、0.001、0.030),术后2组随访均无新增严重主动脉瓣反流或原有二尖瓣反流、三尖瓣反流加重情况,偏心型封堵器组山现完全性左束支传导阻滞2例、少量心包积液、右侧股动脉栓塞各1例.结论 PDA封堵器治疗IVSD的成功率高、并发症少,近中期疗效满意,无严重并发症出现,为IVSD介入治疗提供了新的选择,远期疗效有待进一步随访和更大样本的研究.
목적 평개동맥도관말폐봉도기(PDA봉도기)치료척내형실간격결손(IVSD)적림상료효.방법 2012년7월지2013년9월경피PDA봉도기개입치료IVSD 27례,재술전、술후24 h,술후1、3、6、12개월행초성심동도、심전도、체격검사,여동기사용편심형실간격결손봉도기(편심형봉도기)개입치료IVSD 53례진행대비연구.결과 PDA봉도기성공식입26례、편심형봉도기성공식입42례,2조수술성공솔분별위96.23％、79.25％,평균수방시간위6.78개월(1～ 17개월),2조수술시간、폭광시간、잔여분류방면차이무통계학의의,PDA봉도기조결손직경(t=-3.124,P=0.003)、봉도기직경(t=-4.285,P＜0.001)교편심형봉도기조소,수술성공솔교편심형봉도기조고(x2 =9.099,P=0.011).여술전상비,제우심방내경、좌심실사혈분수무통계학차이외,좌심실서장말기내경、좌심방내경、우심실서장말기내경、주폐동맥내경술후균현저축소(F =57.62、5.002、4.754、2.782,P=0.000、0.033、0.001、0.030),술후2조수방균무신증엄중주동맥판반류혹원유이첨판반류、삼첨판반류가중정황,편심형봉도기조산현완전성좌속지전도조체2례、소량심포적액、우측고동맥전새각1례.결론 PDA봉도기치료IVSD적성공솔고、병발증소,근중기료효만의,무엄중병발증출현,위IVSD개입치료제공료신적선택,원기료효유대진일보수방화경대양본적연구.
Objective To evaluate the clinical effect for transcatheter closure of intracristal ventricular septal defects (IVSD) using duct occluder.Methods Between Jun.2012 and Sep.2013,implantaion of duct occluder was conducted in 27 IVSD pmients,which was compmed with acentric ventricular septal occluder attempted in 53 IVSD patients.The transthoracic echocardiography,electrocardiography,and clinical examination were observed at 24 hours,and after 1,3,6 and 12 months follows-up.Results Implantation of duct occluders were achieved in 26 (96.23 ％) patients and implantation of acentric ventricular septal occluder in 42 (79.25％) patients.The mean follow-up time was 6.78 months (1-17 months).The procedure time,fluoroscopic time and residual shunt were not statistically different between the 2 groups (all p ＞ 0.05).The size of VSD (t =-3.124,P =0.003) and occluder diameter (t =-4.285,P ＜0.001)were smaller and the procedure success rate was higher in the duct occluder group (x2 =9.099,P =0.011).Left ventricular end diastolic dimension,left atrial diameter,left ventricular end diastolic dimension,right ventricular end diastolic dimension and pulmonary artery diameter were decreased significantly (F =57.62,5.002,4.754,2.782,P =0.000,0.033,0.001,0.030) after surgical procedure compared with those before procedure,except for the right atrial diameter and left ventricular ejection fraction.No new serious aortic regurgitation or increased mitral regurgitation,tricuspid regurgitation was shown after procedure in 2 groups.Complete left bundle branch block occurred in 2 patients respectively,pericardial effusion and thromboembolism of right femoral artery occurred in 1 patient in the acentric ventricular septal occluder group.Conclusions The duct occluder for IVSD closure has presented a good result,without serious complications,which provides a new method for IVSD closure.Further studies are necessary to determine the long-term results in a larger population of patients.