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目的:分析微创外科室间隔缺损(ventricular septal defect,VSD)封堵失败原因,以期提高术前超声心动图筛查水平。方法:回顾性分析25例微创外科VSD封堵失败改行修补术病例,对比超声表现及手术所见,归纳总结产生并发症的原因。结果:残余分流与VSD假性膜部瘤右室面具有多个出口和低估VSD大小密切相关:VSD合并主动脉瓣右冠瓣脱垂是主动脉瓣反流的主要原因;封堵器移位与低估VSD大小且使用偏心封堵器有关;原有三尖瓣反流加重和发生Ⅲ度房室传导阻滞VSD均位于隔瓣下方;封堵失败组较封堵成功组缺损偏大,差异具有统计学意义(P<0.05)。结论:超声心动图对VSD及其毗邻结构的细致评估,有助于严格适应证,提高手术成功率。
Objective: To analyze the causes of failure of occlusion of minimally invasive surgical ventricular septal defect (VSD) in order to improve the screening of preoperative echocardiography. Methods: A retrospective analysis of 25 cases of minimally invasive surgical VSD closure failure to divert operation cases, compared with ultrasound findings and surgical findings, summarized the causes of complications. Results: Residual shunt was associated with multiple exits and underestimation of VSD size in the right ventricular surface of VSD pseudo-membranous tumor: VSD with aortic valve right coronary flap prolapse was the main cause of aortic regurgitation; occluder displacement And the underestimation of VSD size and the use of eccentric occluder; the original tricuspid regurgitation and the occurrence of Ⅲ degree atrioventricular block VSD are located below the septal flap; plug failure group than the successful closure of the defect is too large, the difference has Statistical significance (P <0.05). CONCLUSIONS: The careful assessment of VSD and its adjacent structures by echocardiography contributes to strict indications and improves the success rate of surgery.