CAJ | 학술논문

目的探讨经胸骨旁途径微创封堵嵴内型和嵴上型室间隔缺损(VSD)的可行性、安全性和效果.方法全组49例,于胸骨左缘第2或第3肋间作长1.5 ～3.0 cm的切口,不进入胸膜腔,剪开心包.于右心室流出道前壁缝荷包,穿刺,插入携带相应封堵器的特制输送管,在经食管超声引导下,经VSD进入左心室,依次推出封堵器左、右伞,卡闭VSD.结果本组成功封堵47例(96％),其中嵴内型26例,嵴上型21例.VSD平均直径嵴内型(4.4±1.7) mm,嵴上型(2.7±0.9)mm.置入封堵器型号:嵴内型(7.0±2.3) mm,嵴上型(4.8±1.1)mm.心内操作平均(17±16) min.随访3～ 24个月,无封堵器脱落、主动脉瓣受累等并发症.结论经胸骨旁途径微创封堵直径8 mm以下的嵴内型和5 mm以下的嵴上型VSD是简单、安全、可行的.
목적 탐토경흉골방도경미창봉도척내형화척상형실간격결손(VSD)적가행성、안전성화효과.방법 전조49례,우흉골좌연제2혹제3륵간작장1.5 ～3.0 cm적절구,불진입흉막강,전개심포.우우심실류출도전벽봉하포,천자,삽입휴대상응봉도기적특제수송관,재경식관초성인도하,경VSD진입좌심실,의차추출봉도기좌、우산,잡폐VSD.결과 본조성공봉도47례(96％),기중척내형26례,척상형21례.VSD평균직경척내형(4.4±1.7) mm,척상형(2.7±0.9)mm.치입봉도기형호:척내형(7.0±2.3) mm,척상형(4.8±1.1)mm.심내조작평균(17±16) min.수방3～ 24개월,무봉도기탈락、주동맥판수루등병발증.결론 경흉골방도경미창봉도직경8 mm이하적척내형화5 mm이하적척상형VSD시간단、안전、가행적.
Objective To evaluate the feasibility,safety and efficacy of perventricular device closure of supracristal or intracristal ventricular septal defects (VSD) using a minimally invasive technique through a parasternal approach.Methods 49 patients,aged 4 months to 53 years [median 4.8 years],were enrolled in this study.A 1.5 to 3 cm parasternal incision was made in the left second or third intercostal space.The pericardium was incised and cradled without entering the pleural space.Two parallel pursestring sutures were placed at the right ventricular outflow tract.After puncture,the specially designed delivery sheath loaded with the device was inserted into the right ventricle.Under transesophageal echocardiographic guidance,the sheath was advanced through the defect into the left ventricle.Then the device was deployed to close the defect.Results Successful implantation of the device was achieved in 47 patients (96％),including 26 in intracristal group and 21 in supracristal group.The concentric,eccentric,and muscular occluders were used in 17,28 and 2 patients,respectively.The mean diameter of VSD was (4.4 ± 1.7)mm in the intracristal group and (2.7 ± 0.9) mm in the supracristal group.The mean device size was (7.0 ± 2.3) mm and (4.8 ± 1.1)mm in the intralcristal and supracristal group,respectively.The mean intracardiac manipulation time was (17 ± 16) min.During the follow-up period of 3 to 24 months,no device-related complications were found.Conclusion The perventricular device closure of small-sized supracristal or under medium-sized intracristal VSD is feasible,safe,and efficacious through a left parasternal approach.