CAJ | 학술논문

目的：传统经皮室间隔缺损（VSD）封堵术存在放射线及造影剂损伤，本文探讨单纯超声心动图引导下进行经皮VSD封堵术的有效性和安全性。 　　方法：于2014-02至2014-10期间入选先天性VSD患者28例，平均年龄（9.5±3.1）岁，平均体重（31.3±7.7）kg，平均VSD直径（4.6±0.9）mm。患者均在经胸超声心动图引导下行经皮VSD封堵术，封堵后以超声心动图检查评价治疗效果。术后1、3、6、12个月在门诊随访。 　　结果：26例患者在经胸超声心动图引导下成功完成经皮VSD封堵术,1例患者因导管未能沿导丝通过VSD，改超声心动图引导下经胸小切口封堵成功，1例患者因残余分流大于2 mm，改常规外科手术治疗成功。患者的平均手术时间为（63.3±11.7）min，对称型VSD封堵器直径（6.6±1.0）mm；术后即刻微量残余分流2例；平均住院时间为（3.7±1.3）d。所有患者康复出院，无外周血管损伤及心包填塞等并发症。患者术后的平均随访时间为（6.2±3.4）个月，随访1个月时2例患者微量残余分流消失，所有患者未出现心包积液、封堵器脱落、房室传导阻滞和主动脉瓣反流等并发症。 　　结论：单纯超声心动图引导下经皮VSD封堵术不仅安全有效，而且能避免使用放射线及造影剂。
목적：전통경피실간격결손（VSD）봉도술존재방사선급조영제손상，본문탐토단순초성심동도인도하진행경피VSD봉도술적유효성화안전성。 　　방법：우2014-02지2014-10기간입선선천성VSD환자28례，평균년령（9.5±3.1）세，평균체중（31.3±7.7）kg，평균VSD직경（4.6±0.9）mm。환자균재경흉초성심동도인도하행경피VSD봉도술，봉도후이초성심동도검사평개치료효과。술후1、3、6、12개월재문진수방。 　　결과：26례환자재경흉초성심동도인도하성공완성경피VSD봉도술,1례환자인도관미능연도사통과VSD，개초성심동도인도하경흉소절구봉도성공，1례환자인잔여분류대우2 mm，개상규외과수술치료성공。환자적평균수술시간위（63.3±11.7）min，대칭형VSD봉도기직경（6.6±1.0）mm；술후즉각미량잔여분류2례；평균주원시간위（3.7±1.3）d。소유환자강복출원，무외주혈관손상급심포전새등병발증。환자술후적평균수방시간위（6.2±3.4）개월，수방1개월시2례환자미량잔여분류소실，소유환자미출현심포적액、봉도기탈락、방실전도조체화주동맥판반류등병발증。 　　결론：단순초성심동도인도하경피VSD봉도술불부안전유효，이차능피면사용방사선급조영제。
Objective: Traditional percutaneous ventricular septal defect (VSD) closure had disadvantages of radiation and contrast media reaction in relevant patients. We want to investigate the efifcacy and safety of percutaneous VSD closure under solely guidance of echocardiography. Methods: A total of 28 VSD patients treated by percutaneous VSD closure under solely guidance of trans-thoracic echocardiography in our hospital from 2014-02 to 2014-10 were summarized. The patients mean age was (9.5 ± 3.1) years with the body weight at (31.3 ± 7.7) kg. The average diameter of VSD was (4.6 ± 0.9) mm, and the clinical follow-up study was conducted by echocardiography at 1, 3, 6 and 12 months after the procedure. Results: There were 26 patients with successful treatment by percutaneous VSD closure under solely guidance of echocardiography. 1 patient was converted to perventricular closure with trans-esophageal echocardiography guidance because the catheter could not pass through the defect; another patient was converted to surgical repair because of the residual shunt > 2 mm. The average procedural time was (63.3 ± 11.7) min and the mean diameter of symmetrical occluder was (6.6 ± 1.0) mm. There were 2 patients with immediate post-operative residual shunt, and the average in-hospital time was (3.7 ± 1.3) days. All patients discharged without the complications as peripheral vascular injury or cardiac perforation. The average follow-up time was (6.2 ± 3.4) months. The residual shunt disappeared in 2 patients at 1 month follow-up time point. No patients suffered from pericardial effusion, occluder malposition, atrio-ventricular block and aortic valve regurgitation. Conclusion: Echocardiography guided percutaneous VSD closure is safe and effective, it may avoid the radiation and contrast media reaction in relevant patients.