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目的探讨经导管介入治疗室间隔缺损(VSD)的并发症的原因及防治措施。方法415例经导管介入治疗室间隔缺损封堵术患者中发生术中及术后(随访1周~4.5年)并发症74例,对此作回顾性分析,将74例并发症患者分为术中和术后(撤出输送鞘管后)并发症组。结果全组技术成功率92.05%(382/415),并发症总发生率为17.83%(74/415)。415例中封堵术中发生并发症13.98%(58/415),包括心律失常2.65%(11/415),主动脉瓣返流3.61%(15/415);释放封堵器后残余分流6.81%(26/382),其中术后发生溶血0.52%(2/382);封堵器脱落、心脏压塞、三尖瓣损伤、二尖瓣损伤、医源性VSD及呼吸系统并发症各1例(各占0.24%)。封堵术后发生并发症4.19%(16/382),包括心律失常2.09%(8/382),其中伴左室进行性增大0.52%(2/382),术后2天及2年发生Ⅲ度房室传导阻滞并安装临时及永久起搏器各1例(各占0.26%);头痛1.05%(4/382);股动脉血栓形成0.52%(2/382),三尖瓣损伤及穿刺点出血各1例(各占0.26%)。本组无死亡病例。结论经导管介入治疗室间隔缺损并发症发生率低,但迟发严重并发症应引起高度重视,定期严格地随访是十分必要的。
Objective To investigate the causes and prevention and treatment of complications of transcatheter interventricular septal defect (VSD). Methods A total of 74 patients with complications of intraoperative and postoperative follow-up of 1 week to 4.5 years were enrolled in this study. Of the 415 patients who underwent catheterization for ventricular septal defect occlusion, 74 cases were classified as surgery Neutralization and postoperative complications (after withdrawal of delivery sheath). Results The technical success rate was 92.05% (382/415) and the total complication rate was 17.83% (74/415). Among the 415 cases, 13.98% (58/415) of complications occurred in occlusion, including arrhythmia 2.65% (11/415) and aortic valve regurgitation 3.61% (15/415). Residual shunt 6.83 % (26/382), of which hemolysis occurred 0.52% (2/382) postoperatively; occluder shedding, cardiac tamponade, tricuspid valve injury, mitral valve injury, iatrogenic VSD and respiratory complications 1 Example (each 0.24%). Complications after blockade were 4.19% (16/382), including 2.09% (8/382) of arrhythmia, including progressive increase of 0.52% (2/382) in left ventricle, 2 days and 2 years after operation Ⅲ degree atrioventricular block and the installation of temporary and permanent pacemaker in 1 case (each 0.26%); headache 1.05% (4/382); femoral artery thrombosis 0.52% (2/382), tricuspid valve injury And puncture point bleeding in 1 case (each 0.26%). No deaths in this group. Conclusions The incidence of complications of transcatheter interventricular septal defect is low, but late serious complications should be attached great importance. It is very necessary to follow up regularly and strictly.