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目的 :经导管应用Amplatzer封堵器关闭膜周部室间隔缺损 (perimembranousventricularseptaldefect,PMVSD) ,并对其疗效进行初步分析。方法 :18例室间隔缺损 (VSD)中男性 8例 ,女性 10例 ,平均年龄 7 6岁 ,平均体重 2 6 9kg。局麻下行右心导管检查 ,左室造影测量室缺大小 ,经VSD建立股动脉 股静脉轨道 ,封堵器沿传送装置送至左室 ,打开左侧伞并确认铂金标记 (MARK)位于 6点位 ,指向心尖 ,在室间隔右室侧打开右侧伞 ,经超声心动图和左室造影确认封堵器位置良好 ,无残余分流 ,无三尖瓣及主动脉瓣关闭不全后释放封堵器。结果 :18例VSD患者封堵手术均获成功。VSD平均大小 3 9mm ,所选封堵器平均大小 7 1mm ,放射线观察MARK均在 6点位置。封堵效果良好 ,术后 2 4h左室舒张末径明显缩小 ;术后 2 4h仅 2例有微量残余分流 ,无 1例出现主动脉瓣关闭不全 ,无其它严重并发症 ,平均住院3 5d。结论 :经导管应用Amplatzer封堵器关闭膜周部VSD封堵效果好 ,恢复快 ,免除开胸创伤及体外循环等高风险 ,值得进一步推广。
OBJECTIVE: To investigate the perimembranous ventriculo-ventricular septal defect (PMVSD) transcatheter closure with Amplatzer occluder and to analyze its efficacy. Methods: There were 8 males and 10 females in 18 cases of ventricular septal defect (VSD), with a mean age of 7 6 years and an average body weight of 269 kg. Local anesthesia right catheterization, left ventricular angiography measuring the size of the missing room, established by the VSD femoral artery femoral vein track, the occluder sent to the left ventricle along the delivery device, open the left umbrella and confirm the platinum mark (MARK) at 6:00 Bit, point to the apex of the right ventricular septal right ventricular open right umbrella, confirmed by echocardiography and left ventricular occluder occluder good, no residual shunt, no tricuspid valve and aortic valve regurgitation after the release of occluder . Results: All the 18 cases of VSD were successfully blocked. The average size of VSD was 39mm, the average size of the occluder selected was 71mm, and the MARK was observed at 6:00. The occlusion effect was good. The left ventricular end-diastolic diameter was significantly reduced at 24 hours after operation. Only 2 cases had residual trace shunt at 24 hours after operation. No other cases had aortic valve regurgitation and no other serious complications. The average length of hospital stay was 35 days. Conclusion: Transcatheter closure of Amplatzer occluder for VSD has good curative effect, rapid recovery, and avoid the high risk of trauma and cardiopulmonary bypass. It is worth to be further popularized.