Objective To investigate the interventional treatment strategy for occluding the intercristal ventricular septal defect (VSD) in order to improve the surgical safety and success rate. Methods During the period from January 2012 to December 2013, a total of 31 patients with intercristal VSD were admitted to authors’ hospital to receive interventional catheter occlusion therapy. Preoperative color Doppler ultrasound echocardiography showed that on the short axis view of the aorta the VSD interrupted port was situated at 12:00 - 1:00 o’clock region. Left ventricular and above aortic valve angiography indicated that the VSD location, shape and size, the split vent size on the left ventricle side and its distance from the aortic valve could be correctly measured when the VSD shunt was visualized , which were very helpful in guiding the operator to select the suitable occluder as well as to adjust the release pattern of the occluder. Postoperative imaging findings of the left ventricular and above aortic valve angiography were compared with the preoperative ones. Results Successful occlusion of VSD was obtained in 22 patients , in 13 among them the left ventricular angiography showed that the direction of blood flow beam at the defect hole was from the left ventricle to the right ventricle in an obliquely upward direction. The basal width of the defect on the left ventricle side was (5.12 ± 1.38) mm, and(6 - 10) mm occluder was employed. In the remaining 9 patients the left ventricular angiography showed that the direction of blood flow beam at the defect hole was from the left ventricle to the right ventricle in a direction almost parallel to the aortic valve , and the basal width of the defect on the left ventricle side was (7.18 ± 1.26) mm, and (9 - 12) mm zero-bias occluder was adopted. Interventional occlusion of VSD was unsuccessful in 9 cases as the intercristal hole was rather larger, and two of them had coexisting aortic sinus aneurysm complicated by mid-to-severe degree aortic valve regurgitation. Conclusion Based on the precise analysis of angiographic images by experienced radiologists optimal treatment scheme can be worked out. If conditions permit, symmetrical occluder should be employed so far as possible in order to reduce the degree of operation difficulty and improve the surgical safety and the success rate as well.%目的：探讨嵴内型室间隔缺损（VSD）的介入封堵治疗策略，提高手术安全性和成功率。方法2012年1月-2013年12月收治嵴内型VSD患者31例，行导管封堵治疗。术前彩色多普勒超声显示大动脉短轴切面VSD中断口位于12点至1点之间。左室造影显示VSD分流后准确判断VSD的位置、形态和大小，测量左室侧分流口大小、距主动脉瓣的距离，以指导术者选择合适的封堵器，以及封堵器释放的形态调整。对比手术前、后患者左心室和主动脉瓣上的影像资料。结果成功封堵22例，其中13例左室造影表现缺损口血流束方向自左室面到右室面相对于主动脉瓣为斜行向上，缺损左室面基底宽为（5．12±1．38）mm，采用对称型封堵器（6~10 mm）；9例左室造影表现缺损口血流束方向自左室面到右室面相对于主动脉瓣几乎平行，缺损左室面基底宽为（7．18±1．26）mm，采用零偏心型封堵器（9~12 mm）。未成功封堵的9例嵴内型缺损较大，其中2例有主动脉窦瘤合并主动脉瓣中重度返流。结论宜在有经验的影像医师对影像作出准确分析后，选择最优化的治疗方案。在有条件的情况下，尽可能选择对称型封堵器，以减少操作难度，提高手术安全性和成功率。
展开▼
