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目的探讨心脏搏动下经右心室微创封堵婴幼儿肌部室间隔缺损的临床效果。方法回顾性分析2010年1月至2013年1月兰州大学第一医院心血管外科39例肌部室间隔缺损患儿行心脏搏动下经右心室微创封堵肌部室间隔缺损的临床资料,其中男26例、女13例,年龄10个月至3岁,体重6~15 kg。应用经胸超声心动图进行术后随访,观察封堵器的位置,有无移位、有无残余分流、塑型情况及毗邻瓣膜是否开闭等。观察各瓣膜反流情况、各瓣膜口血流及房室腔的变化,心脏功能、肺动脉高压恢复情况等。结果 39例患儿中36例(92.3%)植入封堵器成功封堵,有3例患儿(7.7%)经食管彩色超声心动图(TEE)诊断不适宜行封堵治疗,其中1例由于右心室流出道有异常肌束,2例由于边缘过短不适宜行封堵手术,而改为体外循环下心内直视手术。36例患儿随访6个月以上,经胸超声心动图显示无封堵器脱落、移位,无溶血和房室传导阻滞,人工瓣膜表面光滑,无异物。心脏明显缩小,心功能正常,无神经系统并发症发生。其中3例术后存在轻微的残余分流,随访6个月均消失。结论心脏搏动下经右心室微创封堵肌部室间隔缺损是肌部室间隔缺损一种较优的治疗选择,在经食管彩色超声心动图引导下手术是镶嵌治疗成功的关键,超声科医生与外科医生的合作是手术成功的基础。
Objective To investigate the clinical effect of minimally invasive right ventricle occlusion of infantile muscular ventricular septal defect under cardiac beating. Methods The clinical data of 39 cases of muscular ventricular septal defect treated by minimally invasive right ventricle sealing and muscular ventricular septal defect underwent cardiac beating were retrospectively analyzed from January 2010 to January 2013 in the First Hospital of Lanzhou University. 26 cases, 13 females, aged 10 months to 3 years old, weighing 6 ~ 15 kg. The application of transthoracic echocardiography for postoperative follow-up observation occluder position, with or without displacement, with or without residual shunt, the plastic situation and the adjacent valve is open and close. Observed the valvular regurgitation, valvular orifice flow and atrioventricular cavity changes, cardiac function, pulmonary hypertension recovery and so on. Results Totally 36 (92.3%) implants were implanted in 39 patients. Three patients (7.7%) were diagnosed by transesophageal echocardiography (TEE) unsuitable for occlusion. One patient Due to abnormal right ventricular outflow tract muscle bundle, 2 cases due to the edge is not suitable for closure surgery, but under cardiopulmonary bypass surgery under open heart. Thirty-six children were followed up for more than 6 months. Transthoracic echocardiography showed no vessel occlusion, displacement, no hemolysis and atrioventricular block. The artificial valve surface was smooth and free from foreign body. The heart was significantly reduced, normal heart function, no neurological complications. Three of them had mild residual shunt after operation, and disappeared after 6 months of follow-up. Conclusions Transmyocardial minimally invasive ventricular septal defect occlusion of muscular ventricular septal defect under cardiac beating is an excellent treatment option for VSD. Under the guidance of transesophageal echocardiography, surgery is the key to the success of mosaic therapy. Doctor’s cooperation is the basis of successful operation.