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目的探讨先天性心脏病(先心病)介入治疗中封堵器回收困难的处理方法及安全性,并总结其临床经验。方法26例符合介入治疗条件的先心病患者,室间隔缺损(VSD)16例,房间隔缺损(ASD)4例,动脉导管未闭(PDA)6例,年龄3～16岁,平均(8±2.9)岁,体重13～75kg,平均(23.6±8.2)kg。常规行介入治疗,封堵器打开后因封堵效果不满意,回收封堵器时难以将其收至输送长鞘内,退出体内输送长鞘,选用较大型号的鞘管进行改造后,沿推送杆送至体内封堵器处将其成功回收,而后换用其他型号封堵器进行封堵。结果26例介入治疗中应用常规方法难以回收封堵器的先心病患者,改用较大号自行改造的输送长鞘,均成功将封堵器收回,然后换用其他型号封堵器封堵成功。操作透视时间4.8～13.6min,平均(7.7±2.2)min。封堵即刻及术后3d、1个月、6个月行经胸超声心动图(TTE)、心电图及X线检查,全部患者无残余分流,封堵器位置固定良好,无严重并发症发生。结论采用改造输送长鞘的方法可有效解决先心病介入治疗中封堵器回收困难这一难题,该方法简单、实用、安全及可靠,是处理封堵器回收困难的有效方法。
Objective To investigate the treatment and safety of occluder recovery in the interventional treatment of congenital heart disease (CHD) and to summarize its clinical experience. Methods Sixteen patients with congenital heart disease undergoing interventional therapy were enrolled in this study. There were 16 cases of ventricular septal defect (VSD), 4 cases of atrial septal defect (ASD), 6 cases of patent ductus arteriosus (PDA), 3 to 16 years old (mean, 8 ± 2.9) years old, weighing 13 ~ 75kg, with an average of (23.6 ± 8.2) kg. Conventional interventional therapy, the closure device is not open due to the sealing effect is not satisfied, it is difficult to collect the occluder recovery received within the long sheath, exit the body long sheath delivery, use a larger model of the sheath for transformation, along the Push rod sent to the body occluder at its successful recovery, and then switch to other types of occluder blocking. Results 26 cases of congenital heart disease patients who were difficult to recover the occluder by conventional methods were switched to large-sized self-made delivery of long sheath. The occluders were successfully recovered and replaced with other occluders . Operation perspective time 4.8 ~ 13.6min, an average of (7.7 ± 2.2) min. Immediate closure and postoperative 3d, 1 month, 6 months by transthoracic echocardiography (TTE), ECG and X-ray examination, all patients without residual shunt, occluder position was fixed, no serious complications. Conclusion The modified method of delivering long sheath can effectively solve the difficulty of occlusion device recovery in the interventional treatment of congenital heart disease. The method is simple, practical, safe and reliable and is an effective method to deal with the difficulty of occlusion device recovery.