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背景:对于大入口多出口的膜部瘤型室间隔缺损,如果采用对称型或偏心型室间隔缺损封堵器,有时难以完全封堵。目的:观察A4B2封堵器封堵膜部瘤型室间隔缺损的可行性,根据膜部瘤大小选择合适封堵器对封堵效果的影响。设计:病例分析。单位:河北医科大学第一医院。对象:2004-08/2006-05拟在河北医科大学第一医院行介入治疗的室间隔缺损伴膜部瘤形成226例患者中,对造影术显示膜部瘤为大入口多出口的36例患者应用A4B2封堵器封堵治疗。36例室间隔缺损伴膜部瘤形成患者,造影测量室缺左室面破口(入口)直径平均为(10.6±8.7)mm(8～21mm),右室面均有多个出口,最大右室面破口(出口)直径平均为(3.1±2.9)mm(2～8mm)。主要材料:封堵器与输送装置由上海形状记忆合金材料有限公司和北京华医圣杰科技有限公司生产。采用医用镍钛形状记忆合金等材料,经特殊工艺加工制作成双盘形,专用于先天性心脏病室间隔缺损的封堵治疗。封堵器的型号大小以腰部直径来表示,可选型号为4～16mm。方法:①应用7～10F输送鞘管从右心系统送入相应封堵器。②选择不同型号A4B2封堵器,置入封堵器直径为4～16mm,平均(6.3±2.4)mm。③封堵后15min重复左心室造影和经胸心脏超声检查,观察封堵的即刻效果。封堵后1,3,6,12个月定期进行心电图、心脏超声检查。主要观察指标:封堵后有无残余分流、心律失常以及心脏各瓣膜功能是否受到影响。结果:①封堵膜部瘤左室面破口16例,封堵器完全置于瘤体内封堵瘤体16例,封堵膜部瘤右室面破口4例。②36例患者封堵后15min左心室造影、经胸心脏超声检查显示32例完全封堵,3例造影示少量分流(<3mm),(其中2例发生在封堵器完全置于瘤体内;1例发生在封堵膜部瘤右室面破口封堵后),其中2例24h后心脏超声复查无残余分流,1例1个月后超声复查无残余分流。③术中并发左、右束支传导阻滞分别为3例和2例,均为一过性,1周内恢复。④封堵器置入体内后血小板黏附较少,凝血功能检查、免疫系统反应(免疫球蛋白、补体)、材料表面再内皮化反应均正常,未发生炎症等宿主反应。无封堵器脱落等材料反应发生。结论:经导管采用A4B2封堵器治疗膜部瘤型室间隔缺损,关键在于对膜部瘤大小、形态、位置及膜部瘤组织粘连牢固程度判断并以此来确定封堵部位及选择合适的封堵器。
Background: For large ventricle mucosal septal defects, it is sometimes difficult to block the septum with a symmetrical or eccentric ventricular septal defect occluder. Objective: To observe the feasibility of closure of A4B2 occluder septal defect type septal defect, according to the size of meningioma select the appropriate occluder blocking effect. Design: Case Analysis. Unit: First Hospital of Hebei Medical University. PARTICIPANTS: Totally 226 patients with ventricular septal defect and membranous neoplasia who were involved in the interventional treatment at the First Hospital of Hebei Medical University from August 2004 to May 2006 were enrolled. Among the 36 patients who underwent angiography, Application A4B2 occluder closure treatment. Thirty-six patients with ventricular septal defect and membranous neoplasia had a diameter of (10.6 ± 8.7) mm (8 ~ 21mm) on the left ventricular surface. The diameter of the right ventricular surface had multiple exits Ventricular breakage (exit) average diameter of (3.1 ± 2.9) mm (2 ~ 8mm). The main material: occluder and delivery device from Shanghai Shape Memory Alloy Material Co., Ltd. and Beijing Huayi Shengjie Technology Co., Ltd. production. The use of medical nickel-titanium shape memory alloy and other materials, processed into a special dual-disc shape, dedicated to congenital heart disease Septal defect occlusion treatment. Occluder model size to the waist diameter, the optional model is 4 ~ 16mm. Methods: ① 7 ~ 10F delivery sheath from the right ventricular system into the corresponding occluder. ② choose different types of A4B2 occluder, into occluder diameter of 4 ~ 16mm, an average of (6.3 ± 2.4) mm. ③ 15min after closure of the left ventricular angiography and transthoracic echocardiography to observe the immediate effect of occlusion. 1,3,6,12 months after closure of regular ECG, cardiac ultrasound. MAIN OUTCOME MEASURES: Residual shunt after closure, arrhythmia, and cardiac valve function affected. Results: ① The occlusion of the left side of the membranous tumor in 16 cases, the occluder completely placed in the tumor blocking tumor in 16 cases, the closure of membranous tumor of the right ventricular surface in 4 cases. Thirty-six patients had left ventricular angiography 15 min after occlusion, thoracic and cardiac ultrasonography showed that 32 patients were completely blocked, 3 patients showed small shunt (<3 mm), (2 of them occured completely in the tumor; Cases occurred in the closure of the membrane after the right ventricular septal tear closure), 2 cases of 24 hours after echocardiographic no residual shunt, 1 case 1 month after the ultrasound no residual shunt. ③ intraoperative complications of left and right bundle branch block were 3 cases and 2 cases, were transient, recovery within 1 week. ④ occluder placed in platelets less adhesion, coagulation tests, the immune system response (immunoglobulin, complement), material surface re-endothelialization were normal, no inflammation and other host reactions. No occlusion device off material reaction occurs. Conclusion: Transcatheter A4B2 occluder in the treatment of membranous tumor type ventricular septal defect, the key lies in the size, shape, location of membranous tumor and firmness of membrane tumor tissue adhesion and to determine the site of occlusion and select the appropriate Occluder.