摘要
目的探讨经导管小儿膜部室间隔缺损(perimembranous ventricular septal defects,PMVSDs)介入治疗近期并发症的原因及防治措施。方法对2002年3月—2005年12月间223例小儿PMVSDs介入治疗术中和术后(随访1～18个月)发生并发症的60例进行回顾性分析,将并发症分为严重并发症和轻微并发症两组。结果全组并发症总发生率为26.9%(60/223)。严重并发症9例(4.0%),包括三度房室传导阻滞(AVB)2例(0.9%),机械性溶血3例(1.3%),需外科手术取出封堵器4例(1.8%),其中术中封堵器卡在二尖瓣1例,术后封堵器移位1例(引起溶血),术后封堵器造成主动脉瓣中量反流2例,三度AVB经置入临时起搏器和糖皮质激素及白蛋白等治疗后7天恢复正常心律,2例溶血病例给予糖皮质激素等治疗后溶血消失。轻微并发症51例(22.8%),包括不同类型的束支传导阻滞(bundle branch block,BBB)37例(16.6%),一度AVB2例(0.9%),二度AVB1例(0.4%),新出现主动脉瓣少量反流5例(2.2%),新出现少量至中量以下三尖瓣反流6例(2.6%),除右束支传导阻滞外,其他类型的传导阻滞常规应用糖皮质激素及白蛋白等治疗,绝大多数于短期随访内恢复或好转,新出现的瓣膜反流均未做特殊处理。全组无死亡病例。结论经导管小儿PMVSDs介入治疗近期并发症以轻症为主,严重并发症发生率较低,是一种相对安全的治疗方法;远期并发症的情况需进行长期严格的随访。
Objective To evaluate the early complications during and after transcatheter closure of perimembranous ventricular septal defects （ PMVSDs ） in children. Methods A total of 223 patients received transcatheter closure of PMVSDs from March 2002 to December 2005 in our hospital were included in this retrospective study. Results The overall complications rate was 26. 9% （60/223）. Major complications occurred in 9 patients （4. 0% ） including Ⅲ° atroventricular block （AVB） in 2 （0. 9% ） , hemolysis in 3 （ 1.3% ） and surgical interventions in 4 patients （ 1.8% ） because of device malposition （ 1 ） , mild aortic regurgitation （ 2 ） and device embolization （ 1 ） and all 4 patients recovered without further complications. The 2 patients with Ⅲ° AVB were completely recovered to normal sinus rhythm after 7 days treatment with temporary pacemaker and corticosteroid. Hemolysis in 3 patients disappeared after corticosteroid treatment. Minor complications occurred in 51 patients （22. 8% ） including bundle branch block （BBB） in 37 （ 16.6% ） , first-degree AVB in 2 （0.9%） , second-degree AVB in 1 （0. 4% ） , new-onset mild aortic regurgitation in 5 （ 2. 2% ） and new-onset mild to moderate tricuspid regurgitation in 6 patients （2. 6% ）. Except for right bundle branch blocks, other BBBs were treated with albumin and corticosteroid and completely recovered. No treatment was applied for new-onset valve regurgitations. There was no death in all 223 patients. Conclusions Early complications post PMVSDs in children are mostly minor with good prognosis and the prognosis for major complications post PMVSDs is good after proper treatment.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2006年第11期991-994,共4页
Chinese Journal of Cardiology
基金
国家"十五"科技攻关计划项目(编号:2001BA706B-09)
关键词
室间隔缺损
手术中并发症
手术后并发症
心脏导管插入术
Heart septal defects, ventricular
Intraoperative complications
Postoperative complications
Heart catheterization
