CAJ | 학술논문

目的探讨经右胸—右心房途径微创封堵室间隔缺损(VSD)的可行性、安全性和优势.方法 2011年5月至2012年7月,采用经右胸—右心房途径微创封堵VSD 47例(经右心房组),分年龄段随机选取同期经胸骨正中—右心室途径行微创封堵术的膜周部VSD 47例作为对照(经右心室组).经右心房组手术于胸骨右缘第4或第3肋间、长1.5 ～2.0 cm的切口进胸,于右心房表面缝荷包,穿刺,插入特殊构型的中空探条,经三尖瓣入右心室.在食管超声引导下将探条对准VSD,沿探条孔送入导丝,再送入输送管和封堵器完成封堵.结果两组均封堵成功.经右心房组VSD出口直径2.0～7.0mm,置入封堵器型号4～12 mm.心内操作时间[经右心房组(15 ±13) min,经右心室组(8±5)min]和手术时间[经右心房组(56±24) min,经右心室(72±16) min]组间差异均有统计学意义,P＜0.01.随访1 ～12个月,两组均无封堵器脱落等并发症.结论经右胸—右心房途径微创封堵VSD安全、可行,创伤更小,手术时间更短.
목적 탐토경우흉—우심방도경미창봉도실간격결손(VSD)적가행성、안전성화우세.방법 2011년5월지2012년7월,채용경우흉—우심방도경미창봉도VSD 47례(경우심방조),분년령단수궤선취동기경흉골정중—우심실도경행미창봉도술적막주부VSD 47례작위대조(경우심실조).경우심방조수술우흉골우연제4혹제3륵간、장1.5 ～2.0 cm적절구진흉,우우심방표면봉하포,천자,삽입특수구형적중공탐조,경삼첨판입우심실.재식관초성인도하장탐조대준VSD,연탐조공송입도사,재송입수송관화봉도기완성봉도.결과 량조균봉도성공.경우심방조VSD출구직경2.0～7.0mm,치입봉도기형호4～12 mm.심내조작시간[경우심방조(15 ±13) min,경우심실조(8±5)min]화수술시간[경우심방조(56±24) min,경우심실(72±16) min]조간차이균유통계학의의,P＜0.01.수방1 ～12개월,량조균무봉도기탈락등병발증.결론 경우흉—우심방도경미창봉도VSD안전、가행,창상경소,수술시간경단.
Objective The aim of this study was to evaluate the feasibility,safety and efficacy of peratrial device closure of ventricular septal defect (VSD) through a right parasternal approach.Methods Between May 2011 and July 2012,47 patients (peratrial group),aged 7 months to 37 years,underwent peratrial device closure of VSD through a right parasternal approach.According to the same inclusion criteria,47 patients who underwent perventricular device closure of VSD were randomly chosen as the control group (perventricular group).In the peratrial group,a 1.5 to 2.0 cm parasternal incision was made in the right fourth or third intercostal space.The pericardium was incised and cradled.Two parallel pursestring sutures were placed at the right atrium near the atrioventricular groove.After puncture,a specially designed hollow probe was inserted into the right atrium.The probe was passed through the tricuspid valve into the right ventricle.Under transesophageal echocardiographic guidance,the tip of the probe was adjusted to point to or cross the defect.A flexible guidewire was rapidly inserted into the left ventricle through the channel of the probe to establish a delivery pathway,and the delivery sheath was introduced through the defect over the wire.Then the device was deployed to close the defect.Results Successful implantation of the device was achieved in both groups of patients (100％).In the peratrial group,the entrance and the exit diameter of the VSD were (7.4 ±4.1) mm (range,2.0 to 20.0 mm) and (3.4 ± 1.2)mm (range,2.0 to 7.0 mm),respectively.The mean device size was (6.3 ± 1.5)mm (range,4.0 to 12.0 mm).The mean intracardiac manipulation time is longer in the peratrial group [(15 ± 13) min] than in the perventricular group[(8 ± 5)min],P ＜ 0.01.But the procedure time is shorter in the peratrial group[(56 ± 24) min] than in the perventricular group [(72 ± 16) min],P ＜ 0.01.During the follow-up period of 1 to 12 months,no device-related complications were found.Conclusion The peratrial device closure of VSD is feasible,safe,and efficacious.It has the advantages of less invasiveness,better cosmetic results,and a shorter procedure time.