儿童室间隔缺损并主动脉瓣脱垂51例精准介入治疗的效果
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摘要
目的探讨室间隔缺损(VSD)并主动脉瓣脱垂(AVP)经皮介入精准封堵的可行性和安全性。方法选择2014年1月—2018年6月在本院住院的VSD并AVP病儿51例,经胸心脏超声及升主动脉造影明确VSD及AVP分度;分别选择对称型封堵器、偏心型封堵器、国产新型动脉导管未闭封堵器、AGA ADOⅡ封堵器对VSD并AVP病儿进行精准封堵。术后行心脏超声、心电图随访。结果术前超声心动图提示轻度AVP 4例,未发现中度及以上AVP。术中升主动脉根部造影提示VSD并轻度AVP 38例,中度AVP 6例,重度AVP 7例,其中伴轻微主动脉瓣返流(AR)1例;左心室及升主动脉造影后直接放弃介入治疗5例,试封堵46例,封堵成功39例,国产新型动脉导管未闭封堵器植入13例,偏心型封堵器植入8例,对称型封堵器植入8例,AGA ADOⅡ封堵器植入10例。38例VSD并轻度AVP封堵成功32例,6例VSD并中度AVP封堵成功4例,7例VSD并重度AVP封堵成功3例。封堵成功病儿近中期随访,无严重并发症。结论精准选择恰当型号封堵器是介入治疗VSD并AVP的关键,其近中期疗效可靠,安全性高。
Objective To investigate the feasibility and safety of percutaneous precise occlusion in the treatment of children with ventricular septal defect(VSD)and aortic valve prolapse(AVP). Methods A total of 51 children with VSD and AVP who were hospitalized in our hospital from January 2014 to June 2018 were enrolled.Transthoracic echocardiography and ascending aorta angiography were performed to determine the degree of VSD and AVP,and a symmetrical occluder,an eccentric occluder,a new domestic occluder for patent ductus arteriosus,or an AGA ADO Ⅱoccluder was used for precise occlusion.Echocardiography and electrocardiography were performed for follow-up after surgery. Results Preoperative echocardiography showed mild AVP in 4 children and no moderate or severe AVP was observed.Intraoperative ascending aortic root angiography showed VSD and mild AVP in 38 children,VSD and moderate AVP in 6 children,and VSD and severe AVP in 7 children,among whom one child was found to have mild aortic regurgitation.Five children gave up interventional therapy after left ventricular angiography and ascending aorta angiography;46 patients attempted occlusion and 39 of them achieved successful occlusion,among whom 13 underwent implantation of the new domestic occluder for patent ductus arteriosus,8 underwent implantation of an eccentric occluder,8 underwent implantation of a symmetrical occluder,and 10 underwent implantation of AGA ADO Ⅱ occluder.Among the 38 children with VSD and mild AVP,32 achieved successful occlusion;among the 6 children with VSD and moderate AVP,4 achieved successful occlusion;among the 7 children with VSD and severe AVP,3 achieved successful occlusion.No serious complications were observed during the short-and medium-term follow-up of the children with successful occlusion. Conclusion Accurate selection of an appropriate occluder is the key to a successful interventional treatment of VSD with AVP,with reliable short-and medium-term effects and high safety.
Objective To investigate the feasibility and safety of percutaneous precise occlusion in the treatment of children with ventricular septal defect(VSD)and aortic valve prolapse(AVP). Methods A total of 51 children with VSD and AVP who were hospitalized in our hospital from January 2014 to June 2018 were enrolled.Transthoracic echocardiography and ascending aorta angiography were performed to determine the degree of VSD and AVP,and a symmetrical occluder,an eccentric occluder,a new domestic occluder for patent ductus arteriosus,or an AGA ADO Ⅱoccluder was used for precise occlusion.Echocardiography and electrocardiography were performed for follow-up after surgery. Results Preoperative echocardiography showed mild AVP in 4 children and no moderate or severe AVP was observed.Intraoperative ascending aortic root angiography showed VSD and mild AVP in 38 children,VSD and moderate AVP in 6 children,and VSD and severe AVP in 7 children,among whom one child was found to have mild aortic regurgitation.Five children gave up interventional therapy after left ventricular angiography and ascending aorta angiography;46 patients attempted occlusion and 39 of them achieved successful occlusion,among whom 13 underwent implantation of the new domestic occluder for patent ductus arteriosus,8 underwent implantation of an eccentric occluder,8 underwent implantation of a symmetrical occluder,and 10 underwent implantation of AGA ADO Ⅱ occluder.Among the 38 children with VSD and mild AVP,32 achieved successful occlusion;among the 6 children with VSD and moderate AVP,4 achieved successful occlusion;among the 7 children with VSD and severe AVP,3 achieved successful occlusion.No serious complications were observed during the short-and medium-term follow-up of the children with successful occlusion. Conclusion Accurate selection of an appropriate occluder is the key to a successful interventional treatment of VSD with AVP,with reliable short-and medium-term effects and high safety.
引文
[1]MORI K,MATSUOKA S,TATARA K,et al.Echocardiographic evaluation of the development of aortic valve prolapse in supracristal ventricular septal defect[J].Eur J Pediatr,1995,154(3):176-181.
[2]牟楠楠,郑晓舟,张波,等.经胸彩色多普勒超声心动图在室间隔缺损合并主动脉瓣脱垂介入封堵术中的应用价值[J].中国超声医学杂志,2008,24(2):130-133.
[3]王树杰,谢兆丰,李珊,等.超声心动图诊断膜周部室间隔缺损伴右冠瓣脱垂的可行性[J].实用医学杂志,2016,32(13):2142-2145.
[4]张玉顺,朱鲜阳,张军.先天性心脏病介入治疗与超声诊断进展[M].西安:兴界图书出版公司,2005:183-186.
[5]CHIU S N,WANG J K,LIN M T,et al.Aortic valve prolapse associated with outlet-type ventricular septal defect[J].Ann Thorac Surg,2005,79(4):1366-1371.
[6]中国医师协会儿科医师分会先天性心脏病专家委员会,中华医学会儿科学分会心血管学组,《中华儿科杂志》编辑委员会.儿童常见先天性心脏病介入治疗专家共识[J].中华儿科杂志,2015,53(1):17-24.
[7]韩劲松,王辉山,韩宏光,等.62例室间隔缺损合并主动脉瓣脱垂的外科治疗[J].中国心血管病研究,2012,10(9):685-687.
[8]CHEN G L,LI H T,LI H R,et al.Transcatheter closure of ventricular septal defect in patients with aortic valve prolapse and mild aortic regurgitation:Feasibility and preliminary outcome[J].Asian Pac J Trop Med,2015,8(4):315-318.
[2]牟楠楠,郑晓舟,张波,等.经胸彩色多普勒超声心动图在室间隔缺损合并主动脉瓣脱垂介入封堵术中的应用价值[J].中国超声医学杂志,2008,24(2):130-133.
[3]王树杰,谢兆丰,李珊,等.超声心动图诊断膜周部室间隔缺损伴右冠瓣脱垂的可行性[J].实用医学杂志,2016,32(13):2142-2145.
[4]张玉顺,朱鲜阳,张军.先天性心脏病介入治疗与超声诊断进展[M].西安:兴界图书出版公司,2005:183-186.
[5]CHIU S N,WANG J K,LIN M T,et al.Aortic valve prolapse associated with outlet-type ventricular septal defect[J].Ann Thorac Surg,2005,79(4):1366-1371.
[6]中国医师协会儿科医师分会先天性心脏病专家委员会,中华医学会儿科学分会心血管学组,《中华儿科杂志》编辑委员会.儿童常见先天性心脏病介入治疗专家共识[J].中华儿科杂志,2015,53(1):17-24.
[7]韩劲松,王辉山,韩宏光,等.62例室间隔缺损合并主动脉瓣脱垂的外科治疗[J].中国心血管病研究,2012,10(9):685-687.
[8]CHEN G L,LI H T,LI H R,et al.Transcatheter closure of ventricular septal defect in patients with aortic valve prolapse and mild aortic regurgitation:Feasibility and preliminary outcome[J].Asian Pac J Trop Med,2015,8(4):315-318.