目的：探讨小腰大边型封堵器治疗多出口膜部瘤型室间隔缺损（VSD）的可行性、安全性和疗效。方法自2008年3月-2013年3月，采用国产小腰大边室间隔封堵器对96例膜部瘤型VSD行封堵治疗，封堵前常规行左室造影、升主动脉造影。术后即刻行左室造影、升主动脉造影及经胸超声心动图观察封堵疗效，术后1周和1、3、6、9个月复查经胸超声心动图、心电图及胸部X线片。结果93例膜部瘤型VSD患者封堵成功，成功率96.8%（93/96）。术后发生少量残余分流8例，其中7例48 h后消失，1例1个月随访时亦消失。术后4例出现完全性右束支传导阻滞，5例完全性左束支传导阻滞，1例一过性Ⅲ度房室传导阻滞，出院前均恢复。左室舒张末期内径（LVEDD）由封堵前的（47.5±5.2）mm下降为封堵后的（45.2±5.1）mm（t=18.33，P＜0.01）。术后9个月随访无迟发性心律失常、瓣膜受损及猝死事件。结论小腰大边型封堵器介入封堵膜部瘤型VSD安全有效，近中期疗效好，技术关键是根据膜部瘤的位置、形态、破口大小、数目及距主动脉瓣距离等参数选择封堵器和封堵部位。%Objective To evaluate the feasibility, safety and effectiveness of interventional occlusion with thin waist occluder for perimembranous ventricular septal defect with pseudoaneurysm. Methods During the period from March 2008 to March 2013 at Shanghai Yodak Cardiothoracic Hospital , interventional occlusion with thin waist occluder was carried out in a total of 96 patients with perimembranous ventricular septal defect (VSD) complicated by pseudoaneurysm. The patient’s age varied from 2 years to 36 years. Before the procedure, routine left ventricular angiography and ascending aortic angiography were carried out. Left ventricular angiography and ascending aortic angiography as well as the transthoracic ultrasonography were performed immediately after the procedure to observe the therapeutic results. Follow-up checkups with transthoracic ultrasonography, EKG and chest X-ray film were conducted at one week as well as at one, 3, 6 and 9 months after the surgery were conducted. Results Successful occlusion of VSD was obtained in 93 patients, with a success rate of 96.8% (93/96). After the surgery, small amount of shunt flow was detected in 8 patients, which disappeared within 48 hours in 7 patients, and in the other one the shunt flow disappeared one month later which was confirmed by follow-up examination. After the treatment, complete right bundle branch block occurred in 4 patients, complete left bundle branch block in 5 patients, and transientⅢdegree atrioventricular block in one patient. The conduction block disappeared at the time of discharge in all patients. The left ventricular end-diastolic diameter (LVEDD) decreased from preoperative (47.5 ± 5.2) mm to postoperative (45.2 ± 5.1) mm, the difference was statistically significant (t = 18.33, P < 0.01). During the follow-up period lasting for 9 months, no delayed cardiac arrhythmia, valve damage or sudden death occurred. Conclusion For the treatment of perimembranous ventricular septal defect with pseudoaneurysm, interventional occlusion with thin waist occluder is safe and effective with excellent mid-term effect. Based on the imaging findings, including the location, shape, ruptured orifice, number of the perimembranous pseudoaneurysm as well as the distance between the pseudoaneurysm and the aortic valve, to select suitable occluder and proper occlusion site is the key to ensure a successful surgery.
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