摘要
目的评估食道超声引导下小切口室间隔缺损(室缺)封堵术的疗效。方法 2008年10月～2009年6月,45例先天性室间隔缺损患儿,男27例,女18例,平均年龄3.5岁(14个月～11岁),平均体重16.8 kg(9～30 kg)。经胸心脏超声显示室间隔缺损,8例为嵴内型,36例为膜部型(其中6例伴有膜部瘤形成),1例为肌部型。缺损直径3～10 mm,平均4.5mm。气管插管全身麻醉后,经胸骨下段正中切口,长3～5 cm。在食道超声的引导下,经右室游离壁置入腰部直径5～16 mm的国产室缺封堵器。结果 45例均成功封堵,无中转体外循环病例。42例术后无残余分流,3例封堵后即刻超声示少量残余分流,术后5天复查超声示分流消失。2例术后心电图示右束支传导阻滞,无Ⅲ度房室传导阻滞发生,余43例术后心电图无异常改变。术后住院时间3～7 d,平均4.4 d。随诊3～6个月,1例术后1个月大量心包积液,经心包穿刺后痊愈,余44例均恢复良好,无Ⅲ度房室传导阻滞,无残余分流,无封堵器晚期移位,无瓣膜关闭不全加重。结论食道超声引导下小切口室缺封堵术创伤小,安全性高,近期疗效满意。
Objective To evaluate the efficacy of TEE-guided minimally invasive perventricular device in isolated congenital ventricular septal defect（VSD） closure. Methods From October 2008 to June 2009,45 patients with isolated congenital VSD underwent minimally invasive perventricular closure guided by TEE in our hospital.Of the patients,27 were male,18 were female;the mean age of the patients was 3.5 years（ranged from 14 months to 11 years）;and the mean body weight was 16.8 kg（9-30 kg）.TEE showed intracristal type VSD in 8 patients,and perimembranous type in 36（six of which had aneurysm of membranous septum）,and muscular type in one.The diameter of the VSDs ranged from 3 mm to 10 mm with a mean of 4.5 mm.Under general anesthesia with tracheal intubation,the chest was opened by inferior median sternotomy for 3 to 5 cm.Then,guided by TEE,home-made occluders（5-16 mm in waist diameter） were implanted through the free wall of the right ventricle.Results The occlusion was completed successfully in all of the 45 cases without converting to CPB.After the procedure,3 patients showed trivial residual shun immediately,which however disappeared in 5 days spontaneously.Postoperative ECG showed right bundle branch block in 2 cases without degree Ⅲ A-V block.The 45 patients were discharged from our hospital in 3 to 7 days after the operation（mean,4.4 days）,and then were followed up for 3 to 6 months;during which one patient developed massive pericardial effusion,and was then cured by pericardial drainage.None of the other 44 patients showed degree Ⅲ A-V block,residual shunt,occluder displacement in the later phase,aggravating aortic or tricuspid incompetence. Conclusions TEE-guided minimally invasive closure of isolated congenital VSD is less traumatic and safe with satisfying short-term outcomes.
出处
《中国微创外科杂志》
CSCD
2010年第11期1024-1025,共2页
Chinese Journal of Minimally Invasive Surgery
关键词
室间隔缺损
食道超声
微创治疗
Ventricular septal defect
Echocardiagraphy
Minimally invasive therapy
