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目的探讨经导管采用新型Amp latzer膜部室缺堵闭器关闭儿童膜周室缺的安全性及可行性。方法2002年6月至2004年7月32例膜周部室间隔缺损的患儿接受经导管采用Amp latzer膜部室缺堵闭器的介入治疗,年龄3~15(6.10±2.80)岁,体质量12~31(18.90±5.10)kg,所有病例术前检查证实为膜周部室间隔缺损(PVSD),缺损大小4~13(8.91±2.26)mm,分流口大小2.30~7.00(3.30±1.06)mm,距离主动脉瓣0.50~8.00(4.21±2.10)mm,有假性室隔瘤形成7例(其中2个及以上分流口2例),部分三尖瓣组织附着19例。术后定期行TTE及临床检查随访。结果本组封堵技术成功率100%,堵塞后即刻完全封堵率90.60%,术后6个月完全封堵率96.90%,仅1例存在无血流动力学改变的少许残余分流。除术中有一过性房性、室性早搏、室性心动过速、房室传导阻滞、束支传导阻滞、无1例发生Ⅲ°AVB,栓塞,溶血,封堵器脱落,心内膜炎等并发症,仅2例(6.30%)有轻微主动脉返流,2例有轻度三尖瓣返流,术后病理生理及血流动力学有明显改善,LVDd、LVD s、LA术后明显缩小,MPA流速、MV流速术后明显减慢。随访时间6~22个月。结论经导管采用Amp latzer膜部室缺堵闭器关闭儿童膜周室缺是非常安全、有效可行的非开胸手术方法。长期的安全和有效性有待进一步临床继续随访及累积经验。
Objective To investigate the safety and feasibility of transcatheter closure of perimembranous ventricular septal defect using a new Amp latzer membranous compartment occluder. Methods From June 2002 to July 2004, 32 children with perimembranous ventricular septal defect undergoing percutaneous transluminal angioplasty were treated with Amplatzer membranous compartment occlusion. The age ranged from 3 to 15 (6.10 ± 2.80) years and the body weight 12 ~ (31) (18.90 ± 5.10) kg. All the cases were proved to be PVSD by preoperative examination. The size of defect was 4-13 (8.91 ± 2.26) mm and the size of the shunt was 2.30-7.00 (3.30 ± 1.06) Aortic valve from 0.50 to 8.00 (4.21 ± 2.10) mm, with pseudo-septal tumor formation in 7 cases (of which 2 and above the shunt in 2 cases), part of the tricuspid valve tissue attachment in 19 cases. Regular follow-up TTE and clinical examination. Results The successful rate of blocking technique in this group was 100%. The complete occlusion rate was 90.60% immediately after the occlusion. The occlusion rate was 96.90% at 6 months after operation. Only 1 patient had residual residual diversion without hemodynamic changes. In addition to intraoperative had a sexual, ventricular premature beats, ventricular tachycardia, atrioventricular block, bundle branch block, no case of Ⅲ ° AVB, embolism, hemolysis, occluder shed, intracardiac Meningitis and other complications. Only 2 cases (6.30%) had mild aortic regurgitation, 2 cases had mild tricuspid regurgitation, postoperative pathophysiology and hemodynamics improved significantly, LVDd, LVD s, LA Significantly reduced after surgery, MPA flow rate, MV flow rate was significantly slowed down. Follow-up time of 6 to 22 months. Conclusions Transcatheter closure of the perimembranous ventricular septal defect by Amp latzer membranous ventricular septum closure is a safe, effective and non-thoracotomy method. Long-term safety and effectiveness of the clinical follow-up to be further clinical and accumulated experience.