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目的 探讨膜周部室间隔缺损 (ventricularseptaldefect ,VSD)经导管介入治疗的并发症及其预防。方法 2 0 0 2年 7月 - 2 0 0 4年 5月 ,2 6 2 (男 138,女 12 4 )例膜周部VSD患儿 ,年龄 2～ 18(9 3± 5 8)岁 ,体重 11.0～ 6 5 .0 (平均 30 5 )kg。 3例合并动脉导管未闭 ,4例合并房间隔缺损 ,1例合并动脉导管未闭和房间隔缺损。结果 2 6 2例患儿术前经胸超声检测VSD大小为 2 7～ 13.0mm(平均 6 5mm) ,术中心室造影测量VSD大小为 1 3～ 14 .0mm(平均 6 8mm) ,2 5 6 /2 6 2例 (97 7% )封堵成功。所选封堵器大小为 4～ 16mm (平均 8 6mm)。严重并发症 8例 (3 1% )。其中高度房室传导阻滞(atrioventricularconductionblock ,AVB) 5例 (2 0 % ) ,溶血 2例 (0 8% )。封堵器明显移位 1例 (0 4 % )。5例AVB患儿治疗后除 1例术后 5 0d安装永久起搏器外 ,其余 4例均恢复正常窦性心律。溶血患儿经常规治疗后恢复正常。封堵器明显移位则采用心脏外科手术处理。其他并发症有 :1例 (0 4 % )术后 6个月复查有微量残余分流 ;5例 (2 0 % )术后新出现主动脉瓣微量返流 ;4例 (1 6 % )术后新出现三尖瓣少量返流 ;75例 (2 9% )术后出现间歇性加速性交界性心律或加速性室性自主心律伴干扰性房室脱节 ,治疗后均恢复
Objective To investigate the complications of percutaneous transluminal ventricular septal defect (ventricularseptaldefect, VSD) and its prevention. Methods From July 2002 to May 2004, 266 (male 138, female 124) patients with perimembranous VSD, aged 2-18 (93 ± 58) years and weight 11.0 ~ 6 5 .0 (average 30 5) kg. 3 cases with patent ductus arteriosus, 4 cases with atrial septal defect, 1 case with patent ductus arteriosus and atrial septal defect. RESULTS: Twenty-two children with preoperative transthoracic ultrasound detected VSD size ranged from 27 to 13.0 mm (average 6 mm). The ventricular diastolic diameter (VSD) ranged from 13 to 14.0 mm (mean, 68 mm) / 2 6 2 cases (97 7%) blocked successfully. The size of the occluder selected is 4 to 16 mm (an average of 8 6 mm). Serious complications in 8 cases (31%). Among them, 5 cases (20%) had atrioventricular conduction block (AVB) and 2 cases (0 8%) had hemolysis. Occluder obvious displacement in 1 case (0 4%). 5 cases of AVB children after treatment in addition to a postoperative 50d permanent pacemaker installed, the remaining 4 cases were normal sinus rhythm. Hemolytic children returned to normal after treatment. Significant displacement occluder cardiac surgery. Other complications were as follows: 1 case (0 4%) had a trace residual shunt at 6 months after operation; 5 cases (20%) had new auricular micro-regurgitation; 4 cases (16%) had postoperative A small amount of tricuspid regurgitation occurred. 75 cases (29%) experienced intermittent accelerated borderline arrhythmias or accelerated ventricular autonomic arrhythmias with disturbed atrioventricular disconnection, and all recovered after treatment