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1、多孔膜部瘤室缺单封堵器封堵的临床观察ClinicalObservationsontheTranscatheterClosureonVSDofMultiholeMembranousAneurysmwithDomesticSingleOccluder于连慧高丽芳刘和平孟繁超薛国宏王玉库蒋宝国高迪YuLianhuiGaoLifangLiuHepingMengFanchaoXueGuohongWangYukuJiangBaoguoGaoDi吉林心脏病医院吉林省心脏病研究所(中国130021)川inHeartDiseaseHospital&Heart
2、DiseaseInstitutein川inProvinee(China130021)中图分类号:R541.1/654.2文献标识码:A文章编号:1818-0086(2011)05摘要:目的探讨国产单封堵器对多孔膜部瘤室缺的封堵效果并对其进行术后随访，评价其安全性?方法52例多孔膜部瘤室缺患者?经超声心动图(TTE)确诊，治疗均选用国产对称封堵器进行封堵，首先左室左前斜45。~60。，头位20。造影,根据造影室缺大小?形态选择合适大小的封堵器，建立股动静脉轨道，封堵后即刻左室造影,观察有无残余分流?封堵后随访24h,l?3?6个月J年,随访指标包括心
3、电图?TTE?放射线胸片?结果52例患者51例封堵成功J例封堵成功后发生腱索断裂?其他对主动脉瓣及房室瓣均无影响，无溶血发生J例因2次封堵器置入导致室缺明显增大,2例转入外科手术（包括腱索断裂1例）?1例封堵器植入膜部瘤内?术后即刻造影其中26例有少至微量残余分流，其中20例术后24h分流消失，其余4例于1?3?6个月和1年随访中，发现分流消失;2例有少量分流;TTE显示封堵器位置良好?所有患者对主动脉瓣?房室瓣无影响，无栓塞及感染性心内膜炎事件发生？术后8例心电图发牛不完全性右束支阻滞，随访中5例持续不完全性右束支阻滞;2例完全性右束支传导阻滞,
4、随访中1例持续完全性右束支传导阻滞？术后3-5d内出现交界性逸搏心律3例,经使用肾上腺皮质激素治疗后恢复窦性心律?［例患者在术后第9天发生完全性房室传导阻滞，置入临时起搏器,经肾上腺皮质激素及维生素C治疗,术后第12天恢复窦性心律，仍为左前分支传导阻滞伴完全性右束支传导阻滞?结论不论多孔膜部瘤室间隔缺损距主动脉瓣有无距离均可选择封堵治疗,Qp/Qs>l・5撮人孔<10mm患者均为封堵治疗的适应证，经过2个月至3年的随访，疗效确切？安全？关键词:多孔;单封堵器;封堵AbstractObjectivesToevaluatetheeffica
5、cyandsafetyoftranscatheterclosureonVSDwithmultiholemembranousaneurysmusingsingleoccluderandunderwentpostoperationfollowup.Methods52patientsofVSDwithmultiholeaneurysmwereenrolled.ThediagnosiswascomfirmedbyTTEanddomesticoccluderwereselected.Firstly,measuringthedefectsizebyangiog
6、raphytoselectsuitableoccluder,thenleftventricularangiographyandTTEwereperformedpostoperationimmediatelytoevaluatetheefficacy・ECGandTTE?X・raywereperformed1,3/6monthsand1yearlater.Results51in52patientswereclosedsuccessfully.Brokenchordaetendineaewasfoundin1case・Mildtomodateresid
7、ualshuntin26caseswerefoundbyangiographypostoperationimmediatelyandtheshuntin20casesdisappearedin24hlater;theshuntinother6casesdisappearedin1,3,6monthsand1yearlaterrespectively.Incompleterightbundlebranchblockwerefoundin8cases,and5werefoundcontinued;completerightbundlebranchblo
8、ckwerefoundin2cases.IlldegreeAVBin1casewasfoundin9daysafterop
