心脏搏动下经右心室微创封堵婴幼儿肌部室间隔缺损_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 宋兵 , 刘瑞生 , 唐汉博 , 李元敏

;

Corresponding author：

宋兵, Email: abcsong@sina.com

Keywords：

微创外科; 超声心动图; 肌部室间隔缺损; 婴幼儿

DOI：

10.7507/1007-4848.20140238

Video：

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目的探讨心脏搏动下经右心室微创封堵婴幼儿肌部室间隔缺损的临床效果。方法回顾性分析2010年1月至2013年1月兰州大学第一医院心血管外科39例肌部室间隔缺损患儿行心脏搏动下经右心室微创封堵肌部室间隔缺损的临床资料，其中男26例、女13例，年龄10个月至3岁，体重6～15kg。应用经胸超声心动图进行术后随访，观察封堵器的位置，有无移位、有无残余分流、塑型情况及毗邻瓣膜是否开闭等。观察各瓣膜反流情况、各瓣膜口血流及房室腔的变化，心脏功能、肺动脉高压恢复情况等。结果 39例患儿中36例（92.3%）植入封堵器成功封堵，有3例患儿（7.7%）经食管彩色超声心动图（TEE）诊断不适宜行封堵治疗，其中1例由于右心室流出道有异常肌束，2例由于边缘过短不适宜行封堵手术，而改为体外循环下心内直视手术。36例患儿随访6个月以上，经胸超声心动图显示无封堵器脱落、移位，无溶血和房室传导阻滞，人工瓣膜表面光滑，无异物。心脏明显缩小，心功能正常，无神经系统并发症发生。其中3例术后存在轻微的残余分流，随访6个月均消失。结论心脏搏动下经右心室微创封堵肌部室间隔缺损是肌部室间隔缺损一种较优的治疗选择，在经食管彩色超声心动图引导下手术是镶嵌治疗成功的关键，超声科医生与外科医生的合作是手术成功的基础。

Citation： 宋兵, 刘瑞生, 唐汉博, 李元敏. 心脏搏动下经右心室微创封堵婴幼儿肌部室间隔缺损. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 830-832. doi: 10.7507/1007-4848.20140238 Copy

1.	邢泉生, 任悦义, 段书华, 等.经胸微创非体外循环下封堵膜部室间隔缺损.中国胸心血管外科临床杂志, 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.
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8.	张海波, 徐志伟, 刘锦纷, 等.心内直视杂交封堵肌部多发室间隔缺损.中国微创外科杂志, 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.	唐红, 白文娟, 安琪, 等.经食管超声心动图在经胸微创房间隔和室间隔缺损封堵术中的应用.中华超声影像学杂志, 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.	刘浪, 陈凯明, 赖锋华, 等.杂交技术在法洛四联症治疗中的应用.中国胸心血管外科临床杂志, 2013, 20(1):108-110.
14.	胡盛寿. "一站式"复合技术在心血管外科的应用.中国胸心血管外科临床杂志, 2009, 16(4):249.
15.	郑哲, 李守军, 胡盛寿, 等.分期和"一站式"Hybrid手术治疗法洛四联症合并体肺动脉侧支血管形成的疗效比较.中国胸心血管外科临床杂志, 2009, 16(4):250-253.
16.	刘冀东, 胡振雷, 刘沙, 等.介入封堵术治疗先天性心脏病82例.中国胸心血管外科临床杂志, 2009, 16(6):491-492.

1. 邢泉生, 任悦义, 段书华, 等.经胸微创非体外循环下封堵膜部室间隔缺损.中国胸心血管外科临床杂志, 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. 张海波, 徐志伟, 刘锦纷, 等.复杂畸形伴肌部多发室间隔缺损的直视镶嵌封堵.中华小儿外科杂志, 2011, 32(4):265-268.
8. 张海波, 徐志伟, 刘锦纷, 等.心内直视杂交封堵肌部多发室间隔缺损.中国微创外科杂志, 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. 唐红, 白文娟, 安琪, 等.经食管超声心动图在经胸微创房间隔和室间隔缺损封堵术中的应用.中华超声影像学杂志, 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. 刘浪, 陈凯明, 赖锋华, 等.杂交技术在法洛四联症治疗中的应用.中国胸心血管外科临床杂志, 2013, 20(1):108-110.
14. 胡盛寿. "一站式"复合技术在心血管外科的应用.中国胸心血管外科临床杂志, 2009, 16(4):249.
15. 郑哲, 李守军, 胡盛寿, 等.分期和"一站式"Hybrid手术治疗法洛四联症合并体肺动脉侧支血管形成的疗效比较.中国胸心血管外科临床杂志, 2009, 16(4):250-253.
16. 刘冀东, 胡振雷, 刘沙, 等.介入封堵术治疗先天性心脏病82例.中国胸心血管外科临床杂志, 2009, 16(6):491-492.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

心脏搏动下经右心室微创封堵婴幼儿肌部室间隔缺损

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