心臟搏動下經右心室微創封堵嬰幼兒肌部室間隔缺損_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 宋兵 , 劉瑞生 , 唐漢博 , 李元敏

;

Corresponding?author：

宋兵, Email: abcsong@sina.com

Keywords：

微創外科; 超聲心動圖; 肌部室間隔缺損; 嬰幼兒

DOI：

10.7507/1007-4848.20140238

Video：

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目的探討心臟搏動下經右心室微創封堵嬰幼兒肌部室間隔缺損的臨床效果。方法回顧性分析2010年1月至2013年1月蘭州大學第一醫院心血管外科39例肌部室間隔缺損患兒行心臟搏動下經右心室微創封堵肌部室間隔缺損的臨床資料，其中男26例、女13例，年齡10個月至3歲，體重6～15kg。應用經胸超聲心動圖進行術后隨訪，觀察封堵器的位置，有無移位、有無殘余分流、塑型情況及毗鄰瓣膜是否開閉等。觀察各瓣膜反流情況、各瓣膜口血流及房室腔的變化，心臟功能、肺動脈高壓恢復情況等。結果 39例患兒中36例（92.3%）植入封堵器成功封堵，有3例患兒（7.7%）經食管彩色超聲心動圖（TEE）診斷不適宜行封堵治療，其中1例由于右心室流出道有異常肌束，2例由于邊緣過短不適宜行封堵手術，而改為體外循環下心內直視手術。36例患兒隨訪6個月以上，經胸超聲心動圖顯示無封堵器脫落、移位，無溶血和房室傳導阻滯，人工瓣膜表面光滑，無異物。心臟明顯縮小，心功能正常，無神經系統并發癥發生。其中3例術后存在輕微的殘余分流，隨訪6個月均消失。結論心臟搏動下經右心室微創封堵肌部室間隔缺損是肌部室間隔缺損一種較優的治療選擇，在經食管彩色超聲心動圖引導下手術是鑲嵌治療成功的關鍵，超聲科醫生與外科醫生的合作是手術成功的基礎。

Citation： 宋兵, 劉瑞生, 唐漢博, 李元敏. 心臟搏動下經右心室微創封堵嬰幼兒肌部室間隔缺損. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 830-832. doi: 10.7507/1007-4848.20140238 Copy

1.	邢泉生, 任悅義, 段書華, 等.經胸微創非體外循環下封堵膜部室間隔缺損.中國胸心血管外科臨床雜志, 2010, 17(5):365-369.
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4.	Gan CP, An Q, Lin K, et al. Perventricular device closure of ventricular septal defects:six months results in 30 young children. Ann Thorac Surg, 2008, 86(1):142-146.
5.	Quansheng X, Silin P, Zhongyun Z, et al. Minimally invasive perventricular device closure of an isolated perimembranous ventricular septal defect with a newly designed delivery system:preliminary experience. J Thorac Cardiovasc Surg, 2009, 137(3):556-559.
6.	Zeng XJ, Sun SQ, Chen XF, et al. Device closure of perimembranous ventricular septal defects with a minimally invasive technique in 12 patients. Ann Thorac Surg, 2008, 85(1):192-194.
7.	張海波, 徐志偉, 劉錦紛, 等.復雜畸形伴肌部多發室間隔缺損的直視鑲嵌封堵.中華小兒外科雜志, 2011, 32(4):265-268.
8.	張海波, 徐志偉, 劉錦紛, 等.心內直視雜交封堵肌部多發室間隔缺損.中國微創外科雜志, 2011, 11(5):421-423.
9.	Desjardins G, Cahalan M. The impact of routine trans-oesophageal echocardiography(TOE)in cardiac surgery. Best Pract Res Clin Anaesthesiol, 2009, 23(3):263-271.
10.	唐紅, 白文娟, 安琪, 等.經食管超聲心動圖在經胸微創房間隔和室間隔缺損封堵術中的應用.中華超聲影像學雜志, 2008, 17(7):557-559.
11.	Schmitz C, Esmailzadeh B, Herberg U, et al. Hybrid procedures can reduce the risk of congenital cardiovascular surgery. Eur J Cardiothorac Surg, 2008, 34(4):718-725.
12.	Patel HT, Hijazi ZM. Pediatric catheter interventions:a year in review 2004-2005. Curr Opin Pediatr, 2005, 17(5):568-573.
13.	劉浪, 陳凱明, 賴鋒華, 等.雜交技術在法洛四聯癥治療中的應用.中國胸心血管外科臨床雜志, 2013, 20(1):108-110.
14.	胡盛壽. "一站式"復合技術在心血管外科的應用.中國胸心血管外科臨床雜志, 2009, 16(4):249.
15.	鄭哲, 李守軍, 胡盛壽, 等.分期和"一站式"Hybrid手術治療法洛四聯癥合并體肺動脈側支血管形成的療效比較.中國胸心血管外科臨床雜志, 2009, 16(4):250-253.
16.	劉冀東, 胡振雷, 劉沙, 等.介入封堵術治療先天性心臟病82例.中國胸心血管外科臨床雜志, 2009, 16(6):491-492.

1. 邢泉生, 任悅義, 段書華, 等.經胸微創非體外循環下封堵膜部室間隔缺損.中國胸心血管外科臨床雜志, 2010, 17(5):365-369.
2. Butera G, Carminati M, Chessa M, et al. Transcatheter closure of perimembranous ventricular septal defects:early and long-term results. J Am Coll Cardiol, 2007, 50(12):1189-1195.
3. Li F, Chen M, Qiu ZK, et al. A new minimally invasive technique to occlude ventricular septal defect using an occluder device. Ann Thorac Surg, 2008, 85(3):1067-1071.
4. Gan CP, An Q, Lin K, et al. Perventricular device closure of ventricular septal defects:six months results in 30 young children. Ann Thorac Surg, 2008, 86(1):142-146.
5. Quansheng X, Silin P, Zhongyun Z, et al. Minimally invasive perventricular device closure of an isolated perimembranous ventricular septal defect with a newly designed delivery system:preliminary experience. J Thorac Cardiovasc Surg, 2009, 137(3):556-559.
6. Zeng XJ, Sun SQ, Chen XF, et al. Device closure of perimembranous ventricular septal defects with a minimally invasive technique in 12 patients. Ann Thorac Surg, 2008, 85(1):192-194.
7. 張海波, 徐志偉, 劉錦紛, 等.復雜畸形伴肌部多發室間隔缺損的直視鑲嵌封堵.中華小兒外科雜志, 2011, 32(4):265-268.
8. 張海波, 徐志偉, 劉錦紛, 等.心內直視雜交封堵肌部多發室間隔缺損.中國微創外科雜志, 2011, 11(5):421-423.
9. Desjardins G, Cahalan M. The impact of routine trans-oesophageal echocardiography(TOE)in cardiac surgery. Best Pract Res Clin Anaesthesiol, 2009, 23(3):263-271.
10. 唐紅, 白文娟, 安琪, 等.經食管超聲心動圖在經胸微創房間隔和室間隔缺損封堵術中的應用.中華超聲影像學雜志, 2008, 17(7):557-559.
11. Schmitz C, Esmailzadeh B, Herberg U, et al. Hybrid procedures can reduce the risk of congenital cardiovascular surgery. Eur J Cardiothorac Surg, 2008, 34(4):718-725.
12. Patel HT, Hijazi ZM. Pediatric catheter interventions:a year in review 2004-2005. Curr Opin Pediatr, 2005, 17(5):568-573.
13. 劉浪, 陳凱明, 賴鋒華, 等.雜交技術在法洛四聯癥治療中的應用.中國胸心血管外科臨床雜志, 2013, 20(1):108-110.
14. 胡盛壽. "一站式"復合技術在心血管外科的應用.中國胸心血管外科臨床雜志, 2009, 16(4):249.
15. 鄭哲, 李守軍, 胡盛壽, 等.分期和"一站式"Hybrid手術治療法洛四聯癥合并體肺動脈側支血管形成的療效比較.中國胸心血管外科臨床雜志, 2009, 16(4):250-253.
16. 劉冀東, 胡振雷, 劉沙, 等.介入封堵術治療先天性心臟病82例.中國胸心血管外科臨床雜志, 2009, 16(6):491-492.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

心臟搏動下經右心室微創封堵嬰幼兒肌部室間隔缺損

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