食道超声下单纯经股静脉封堵膜周型室间隔缺损技术的临床应用

发布时间：2018-06-08 23:21

本文选题：膜周型室间隔缺损 + 食道超声心动图　；参考：《中南大学学报(医学版)》2017年07期

【摘要】：目的:探讨食道超声引导下行单纯经股静脉路径封堵膜周型室间隔缺损的可行性及安全性。方法:选择2014年1月1日至2016年5月31日在中南大学湘雅二医院就诊的膜周型室间隔缺损患者26例,年龄3.2~6.0(4.3±0.7)岁,体重15.0~19.5(16.7±1.4)kg,直径3.5~4.8(4.1±0.3)mm。患者均在食道超声引导下行单纯经股静脉路径封堵膜周型室间隔缺损,封堵后以食道超声和经胸超声检查评价治疗效果。患者术后第1,3,6,12个月在门诊复查随访。结果:20例患者在食道超声引导下成功完成经股静脉膜周型室间隔缺损封堵术,成功率76.9%。2例因建立轨道失败,4例因输送鞘未能沿导丝通过室间隔缺损,均改经胸小切口,封堵成功。20例患者全部使用等边型室间隔缺损封堵器,封堵器直径为6.0~7.0(6.2±0.4)mm,手术操作时间为12.0~64.0(26.8±6.3)min,ICU滞留时间1.8~2.4(2.1±0.3)h,住院时间为4.0~5.0(4.4±0.5)d。术后即刻微量残余分流3例,不完全右束支传导阻滞3例。所有患者均痊愈出院,且无外周血管损伤、三尖瓣返流、心包填塞及肺部感染等并发症。患者术后均定期随访,随访第1个月时3例微量残余分流患者微量残余分流消失,3例不完全右束支传导阻滞患者恢复正常心律。所有患者未出现封堵器脱落、残余分流、心包积液、心律失常(房室传导阻滞)和主动脉瓣及三尖瓣返流等并发症。结论:食道超声引导下行单纯经股静脉封堵膜周型室间隔缺损是可行的且安全有效的介入技术。
[Abstract]:Objective: to investigate the feasibility and safety of transfemoral venous closure of perimembranous ventricular septal defect (VSD) guided by esophagus. Methods: from January 1, 2014 to May 31, 2016, 26 patients with perimembranous ventricular septal defect (VSD) were selected from Xiangya No.2 Hospital, Central South University. Their age was 3. 2 卤6. 0 卤0. 7) years old, weight was 15. 0 ~ 19. 5U ~ (19. 5) 卤1. 4 卤1. 4 mg / kg, diameter was 3. 54.8U 4. 1 卤0. 3mm. All the patients were treated with transfemoral vein via femoral vein pathway for the closure of peri-membranous ventricular septal defect under the guidance of esophagus ultrasound, and the therapeutic effect was evaluated by esophageal ultrasound and transthoracic ultrasound. The patients were followed-up in outpatient department for 6 days and 12 months after operation. Results under the guidance of esophageal ultrasound, 20 patients successfully completed transfemoral vein closure of peri-membranous ventricular septal defect. The success rate of 76.9.2 cases was changed to transthoracic small incision due to the failure of track building in 4 cases because the sheath could not pass through the ventricular septal defect along the guide wire. All 20 patients were successfully occluded with equilateral ventricular septal defect occluder. The diameter of the occluder was 6.0 卤7.0 卤0.4 mm, the operative time was 12.0 ~ 64.0 卤26.8 卤6.3 min, the stay time of ICU was 1.82.42 卤0.3 hours, and the hospitalization time was 4.05.04.4 卤0.5 days. There were 3 cases of residual shunt and 3 cases of incomplete right bundle branch block. All patients were cured and discharged without peripheral vascular injury, tricuspid regurgitation, pericardial tamponade and pulmonary infection. All the patients were followed up regularly. At the first month, 3 patients with residual shunt disappeared and 3 patients with incomplete right bundle branch block returned to normal rhythm. No complications such as occluder loss, residual shunt, pericardial effusion, arrhythmia (atrioventricular block) and aortic and tricuspid regurgitation were found in all patients. Conclusion: transfemoral vein closure of perimembranous ventricular septal defect is a safe and effective interventional technique under the guidance of esophagus ultrasound.
【作者单位】：中南大学湘雅二医院小儿心血管外科;中南大学湘雅二医院心脏超声专科;
【分类号】：R725.4

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