书作者单位:710032西安,第四军医大学西京医院心脏内科(张玉顺、李寰、刘建平、代政学、王垒、王晓燕),超声科(张军、李军)·论著·膜周部室间隔缺损介入治疗并发症的分析张玉顺李寰刘建平代政学王垒张军李军王晓燕【摘要】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2002年7月-2004年5月,262(男138,女124)例膜周部VSD患儿,年龄2~18(9.3±5.8)岁,体重11.0~65.0(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262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),256/262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50d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(29%)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,治疗后均恢复正常;41例(16%)术后出现不完全性或完全性右束支传导阻滞;4例(1.6%)术后出现完全性左束支传导阻滞。结论经导管介入治疗膜周部VSD的严重并发症发生率低,是相对安全、疗效可靠的治疗方法。【关键词】室间隔缺损;手术后并发症ComplicationsoftranscatheterinterventionalocclusionofventricularseptaldefectsZHANGYu-shun,LIHuan,LIUJian-ping,DAIZheng-xue,WANGLei,ZHANGJun,LIJun,WANGXiao-yan.DepartmentofCardiology,XijingHospital,4thMilitaryMedicalUniversity,Xi'an710032,China【Abstract】ObjectiveToinvestigatethecomplicationsandtheirpreventioninpatientswithperimembranousventricularseptaldefect(VSD)experiencingtranscatheterinterventionalocclusion.MethodsFromJuly,2002toMay,2004,totally262(138males,124females)perimembranousVSDpatientsunderwenttranscatheterinterventionalocclusioninthedepartment.Theagerangedfrom2to18years(mean9.3±5.8years),andthebodyweightrangedfrom11.0to65.0kg(mean30.5kg).TheimplantedoccluderwithimportedAmplatzereccentricperimembranousVSDoccluder,domesticdouble-disk,domesticeccentricperimembranousVSDandPDAoccluderwereattemptedin12,212,28and6cases,respectively.Amongthem,3caseswerecomplicatedwithductusarteriosus,4withatrialseptaldefectsand1withpatentductusarteriosusplusatrialseptaldefect.Theassociateddefectsweretreatedwithotheroccludersatthesametime.ResultsThediametersofVSDmeasuredbytransthoracicechocardiographybeforeocclusionandbyventriculographyduringtheprocedurerangedfrom2.7to13mm(mean6.5mm)andfrom1.3to14.0mm(mean6.8mm),respectively.Thedefectsin256cases(97.7%)weresuccessfullyoccluded.Theimplantoccluderwasfrom4to16mminsize.Seriouscomplicationsoccurredin8cases(3.1%),including5casesofhighdegreeatrioventricularblock(AVB)(2.0%),2casesofhemolysis(0.8%)and1caseofdisplacementoftheoccluder(0.4%).Amongst5casesofhighdegreeAVB,permanentpacemakerwasimplantedonlyin1caseduetohighdegreeAVB50daysaftertreatment,whereastheothersallrecovered.Twocasesofhemolysiswerecompletelyrecovered.Onecaseofoccluderdisplacementwasemergentlytransferredtocardiacsurgery.Othercomplicationsincludedresidualshuntduring6monthfollow-upin1case(0.4%),minoraorticregurgitationin5cases(2.0%),minortricuspidregurgitationdur...