【摘要】 目的:观察国产封堵器封堵先天性膜部室间隔缺损的安全性,及封堵前后左心功能和血流动力学指标的变化。方法:①对象:选择2003-08/2006-03安徽医科大学第一附属医院心内科应用国产封堵器治疗先天性膜部室间隔缺损患者82例。男43例,女39例;平均年龄(14.3±10.7)岁。其中26例为膜部瘤,1例合并房间隔缺损。②方法:术中经左心室造影确定室间隔缺损的位置、大小及形态,造影后经股动脉送入Judkin右冠状动脉造影导管至左心室,调整导管通过缺损处进入右心室,送入面条导丝至肺动脉或上腔静脉,经股静脉送入圈套器达肺动脉或上腔静脉,套住导丝拉出体外,建立股动脉至股静脉轨道。沿轨道钢丝经股静脉侧送入6-9F输送鞘管至左心室,透视和经胸超声心动图监视下释放封堵器,在左心室释放左心室面伞,轻轻回撤整个输送系统,当左心室面伞紧贴室间隔时,释放右心室面伞,经胸超声心动图和左心室造影证实封堵器位置良好,无心室水平左向右分流,主动脉瓣和三尖瓣功能未受影响,表明封堵成功。③评估:封堵前、封堵后3d、1个月、1年行经胸超声心动图检查,观察左房内径、左室舒张末期内径、左室收缩末期内径、射血分数、每搏输出量、左室短轴缩短率的大小及变化。结果:78例成功置入封堵器,治疗成功率95%。左心室造影测量缺损直径为2～12(5.1±2.4)mm,封堵器直径4～14(6.7±2.9)mm。经胸超声心动图随访过程中所有封堵器位置及形态良好,封堵后行左心室造影,1例有少许残余分流,1个月后残余分流消失。封堵后3d、1个月及1年左房内径、左室舒张末期内径、左室收缩末期内径、每搏输出量较封堵前明显缩小﹙P<0.01﹚,而封堵后3d、1个月射血分数、左室短轴缩短率无明显变化,封堵后1年射血分数、左室短轴缩短率较封堵前显著下降﹙P<0.05﹚,且上诉6项指标均恢复正常。结论:国产封堵器应用于先天性膜部室间隔缺损未发现特殊生物相容性问题,能够有效的改善室间隔缺损患者的左心功能。更多还原

【Abstract】 AMI: To explore the safety of ventricular septal defect occluder (HVSO) from domestic source and observe the changes of left ventricular function and hemodynamics. METHODS: ①From August 2003 to March 2006, 82 patients with congenital membranous ventricular septal defect (CMVSD) were treated with HVSO in Department of Cardiology, First Affiliated Hospital of Anhui Medical University. There were 43 males and 39 females averagely aged (14.3±10.7) years. Of the subjects, 26 patients had membranous aneurysm and 1 case associated with atrial septal defect. ②Transthoracic echocardiography was performed to confirm the location, size and appearance of ventricular septal defect, Judkin coronary arteriography catheter was inserted to left ventricle via femoral artery, and into right ventricle through the defect site. Guide wire was located at lung artery or superior vena cava; snare was sent to lung artery or superior vena cava via femoral vein to encase the guide wire and pull out the body. The track from femoral artery to femoral vein was built. 6-9 F sheathing canal was inserted to left ventricle along the track via femoral vein; the occluder was released under transthoracic echocardiography to the left ventricle umbrella, lightly pulled the whole transfer system, and released the right ventricle umbrellar until the left ventricle umbrella tightly attached the interventricular septum. When the transthoracic echocardiography and left ventricle imaging suggested the occluder located appropriately with no left to right shunt or changes in the function of aortic valve and tricuspid valve, the occlusion was successful. ③Transthoracic echocardiography was performed to observe left atrial diameter (LA), left ventricle end-diastole diameter (LVEDD), left ventricle end-systole diameter (LVESD), ejection fraction (EF), stroke volume (SV), fraction shortening (FS) pre-operatively and 3 days, 1 month, and 1 year post-operatively. RESULTS: HVSO was implanted successfully in 78 patients. The success rate was 95%. The average defect diameter was (5.1± 2.4) mm (range, 2–12 mm) and the average HVSO diameter was (6.7±2.9) mm (range, 4–14 mm) by LVI. Transthoracic echocardiography suggested all the occluders located in proper positions and their shapes were good. Trivial shunt remained only in 1 case but disappeared after 1 month. Three days, one month and one year after occlusion, LA, LVEDD, LVESD, and SV decreased significantly (P < 0.01). EF and FS did not change remarkably 3 days and 1 month after surgery, but reduced markedly after one year (P < 0.05). CONCLUSION: HVSDO for transcatheter occlusion of CMVSD dose not have any specific biocompatibility problem. It can improve the left ventricular function.更多还原