摘要:目的:分析微創外科室間隔缺損(ventricular septal defect,VSD)封堵失敗原因,以期提高術前超聲心動圖篩查水平。方法:回顧性分析25例微創外科VSD封堵失敗改行修補術病例,對比超聲表現及手術所見,歸納總結產生并發癥的原因。結果:殘余分流與VSD假性膜部瘤右室面具有多個出口和低估VSD大小密切相關;VSD合并主動脈瓣右冠瓣脫垂是主動脈瓣反流的主要原因;封堵器移位與低估VSD大小且使用偏心封堵器有關;原有三尖瓣反流加重和發生Ⅲ度房室傳導阻滯VSD均位于隔瓣下方;封堵失敗組較封堵成功組缺損偏大,差異具有統計學意義(Plt;0.05)。結論:超聲心動圖對VSD及其毗鄰結構的細致評估,有助于嚴格適應證,提高手術成功率。 Abstract: Objective:To analyze the failure of perventricular closure of ventricular septal defect (VSD), in order to improve the preoperative echocardiography examination. Methods: Twentyfive cases underwent surgical repair after failure of perventricular closure of VSD were included in this study. With combination of echocardiographic and surgical findings, retrospective analysis of the failure of perventricular closure of VSD were attempted to summarize the cause of complications.Results: Residual ventricular communication was due to underestimation of size of VSD and pseudomembranous aneurysm resulting in multiple outlets of VSD on the right ventricle side; preoperative prolapse of rightcoronary cusp was the main reason for mild or greater than mild aortic valve regurgitation after eccentric device closure of VSD; Underestimation of the size of VSD and using eccentric occluder device were responsible for the displacement of VSD occluder device. Postoperative aggravated tricuspid regurgitation and Ⅲ°atrialventricular block (AVB) were attributed to VSDs located under the septal leaflet of tricuspid valve. The size of VSD in group of failed perventricular device closure of VSD was larger than that in group of successful device closure of VSD,and the difference was significant(Plt;0.05). Conclusion: Echocardiography vividly reveals VSD and adjacent structures, which should be used in accessing the anomaly and defect and formulating surgical plans to reduce surgical morbidity and mortality.