【摘要】 目的:探讨嵴内型室间隔缺损介入治疗适应证选择,并评价其近期疗效。方法:2004年3月至2005年11月,采用国产新型零偏心室间隔缺损(VSD)封堵器对49例嵴内型VSD患者进行封堵治疗,其中男25例,女24例,年龄2．5～15(6．2±3．6)岁。经胸超声心动图显示VSD的直径2～10(5．2±2．3)mm。所有患者在透视及超声监测下通过建立股动静脉轨道,经右心系统释放封堵器,并分别于术后1、3、6、12个月通过经胸超声心动图检查、12导联心电图检查等,从残余分流、瓣膜功能、心功能、心电图及封堵器直径变化率5方面进行随访评价。结果:45例患者封堵器置入成功,技术成功率91．8％。4例未成功者分别为:3例为伴有主动脉瓣脱垂者,1例为超声判断误差。42例患者接受了1～12(平均8．6)个月的随访,所有随访病例中,无新增加的三尖瓣关闭不全,无主动脉瓣穿孔,2例出现少量主动脉瓣反流者,其中1例为封堵器出现微移位。无其他严重并发症发生。封堵器置入即刻及术后6个月,左心室舒张末径发生进行性缩小,而右心室舒张末前后径及射血分数未见明显变化。封堵器置入24 h,封堵器腰部直径较置入即刻发生轻微变化,术后1、3、6、12个月随访无明显变化。结论:缺损直径在10 mm以内且无病理性主动脉反流的嵴内型VSD可以选择介入治疗,其近期效果良好。更多还原

【Abstract】 Objective:To investigate indications of transcatheter closure of intracristal ventricular septal defects ( VSD) and evaluate its short-term efficacy. Methods:From March 2004 to November 2005 ,49 patients (25 males,24 females) with intracristal VSD underwent catheter closure with a new type device specially designed for intracristal VSD. The mean age of patients was 6. 2±3. 6 years (range 2. 5 to 15 years) ; the mean diameter of VSD measured by transthoracic echocardiography (TTE) was 5. 2±2. 3 mm ( range 2 to 10 mm). Occluder was released through right heart system. After procedures, in order to evaluate the residual shunt, valve function, heart function, eletrocardiographic findings and the variety rate of occluder waist diameter, follow-up was made with TTE and echocardiography at 1 ,3,6 and 12 months after procedures. Results:The devices were deployed successfully in 45 patients(the successful rate was 91. 8% ). Of 4 unsuccessful cases,3 were complicated with right coronary valveprolapse and 1 mistakenly judged by TTE. During the period of follow-up (1-12 months, mean 8. 6 months ) , no tricuspid regurgitation or aortic valve perforation in 42. The occluder was trivial by displaced in one of two cases which had light aortic regurgitation. Left ventricular end-diastolic diameter was shrinked gradually during 6-month follow-up while right ventricular end-diastolic diameter and ejection fraction had no obvious change. Occluder’s waist diameter had slight change 24 hours after procedures,but no obvious change at 1 ,3,6 and 12 months after procedures. Conclusion: Intracristal VSD with a diameter≤10 mm without aortic regurgitation may be closured by transcatheterization with a good short-term results.更多还原