中国实用儿科杂志

中国实用儿科杂志 ›› 2012, Vol. 27 ›› Issue (2): 109-111.

• 论著 • 上一篇    下一篇

第二代动脉导管未闭封堵器封堵
特殊类型室间隔缺损2例报告

赵鹏军a，高　伟a，余志庆a，钟玉敏b，黄美蓉a，张志芳a，曹剑锋b，李　奋a   

  1. 上海交通大学医学院附属上海儿童医学中心  a 心内科  b 放射科，上海　200127
  • 出版日期:2012-02-06 发布日期:2012-04-12

The clinical evaluation of transcatheter closure of ventricular septal defects with special appearance using the Amplatzer duct occluder Ⅱ.

  • Online:2012-02-06 Published:2012-04-12

摘要：

目的　总结分析应用第二代动脉导管未闭封堵器（ADO-Ⅱ）对特殊类型室间隔缺损（VSD）封堵的技巧。方法　研究对象为2011年8月至9月在上海交通大学医学院附属上海儿童医学中心行介入治疗的患儿2例，因应用常规VSD封堵器封堵困难，遂选取ADO-Ⅱ进行治疗。常规建立动静脉轨迹后，采用主动脉内释放，然后行左室、升主动脉造影和心脏超声检查，如封堵器位置好，无残余分流、瓣膜反流则释放。结果　例1左室造影显示为膜周VSD，左室面7.6 mm，较大假性室隔瘤形成，右室分流口弥散，最大约2.3 mm，缺损上缘距主动脉为6.1 mm。导丝建轨后，7 F长鞘无法通过分流口，最后选用5F长鞘，“6 mm×4 mm”的ADO-Ⅱ封堵成功，术后心脏超声三尖瓣轻微分流。例2心室造影为肌部VSD，左室面6.3 mm，右室分流口为2 mm，上缘距主动脉16 mm。因VSD走行异常且分流口小，最终选冠脉导丝建轨成功，应用4 F长鞘，“4 mm×4 mm”ADO-Ⅱ封堵成功。2例患儿术后1d复查心脏超声和心电图，无异常，观察5 d后出院随访，并口服阿司匹林［3～5 mg/（kg·d）］。结论　对于一些形态较特殊的VSD，常规VSD封堵器无法成功封堵时，可选择ADO-Ⅱ进行封堵，手术操作简单、安全、可靠而并发症少。

Abstract:

Objective To evaluate the techniques and results of transcatheter closure of ventricular septal defects with special appearance using the new Amplatzer duct occluder Ⅱ（ADO-Ⅱ）. Methods　Two patients were included in the study，one female， 6 years old， perimembranous ventricular septal defect（pmVSD） with a conspicuous aneurysm-like formation and a cauliflower appearance；the other was male， 5 years old， muscular VSD（mVSD）；it was difficult to close with VSD occluder and then it was decided to use the new ADO-Ⅱ. After the ateriovenous loop was constructed， the left retention flanges were released in ascending aorta. If no residual shunt was found and the positionwas good with aortic angiogram and echocardiogram， ADO-Ⅱ was released eventually. Taking echocardiogram and electrocardiogram one day after procedure， and the patients were discharged from hospital 5 days later，with aspirin orally （3～5 mg/kg/d） taken in follow-up. Results　In patient 1 with pmVSD after a left ventricular angiogram， the defect was with a conspicuous aneurysm-like formation and a cauliflower appearance， multiple exit holes on the right side of the defect， the largest size of holes was about 2.3 mm， and the size of inlet on the left side was 7.6 mm， the distance from the aortic valve was 6.1 mm. 7F sheath was unable to be delivered across the hole through arteriovenous loop and the VSD was closed with a 5F delivery sheath and ”6×4” ADO-Ⅱ eventually， trivial tricuspid regurgitation existed by TTE after procedure. In patient 2 with mVSD， the size of hole on the left side was 6.3 mm and that of the right side was 2 mm， the distance from aortic valve was 16 mm. It was a smaller tunnel-like defect， with an oblique course toward the inlet septum. The defect was successful closedly with 4F sheath and “4×4” ADO-Ⅱ. The results of EKG were normal after the procedure. Conclusion　Transcatheter closure of VSD with special appearance using Amplatzer duct occluder Ⅱ is a good alternative selection when it is difficult to close with VSD occluder. It is a feasible， safe and effective method with few complications.

Key words: Amplatzer duct occluder Ⅱ, ventricular septal defects, interventional therapy