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经胸微创室间隔缺损封堵术38例临床分析

目的 探讨食管超声心动图（ TEE）引导下应用国产封堵器经胸微创封堵室间隔缺损（VSD）的临床价值。方法 回顾性分析自2011年5月至2012年5月内蒙古医学院第一附属医院38例VSD患者的临床资料，，男20例，女18例；年龄2.6～13.0岁；体重10～35 kg。其中膜部VSD 30例，干下型VSD 6例，肌部VSD 2例。术前经胸超声心动图检查符合封堵条件者在全身麻醉下经口插入食管超声探头，手术开始前重新评估VSD是否符合封堵治疗，如符合，根据VSD最大直径选择合适的封堵伞。于手术开始后，监测整个封堵过程，引导封堵伞的位置，评价即刻封堵效果，确认是否有残余分流及并发症。 结果 38例患者均一次封堵成功，置入封堵器直径4～10 mm，TEE显示封堵器与VSD边缘吻合紧密无残余分流。术后4～7 d复查心脏彩色超声心动图提示封堵器位置正常、牢固，无残余分流，主动脉瓣无反流。随访31例，随访时间10～24个月，未出现新的瓣膜和主动脉瓣反流，无溶血和血栓形成，无封堵器位置移动现象，未发现左、右心室流出道狭窄，手术切口隐蔽，基本不影响美观。 结论经胸微创VSD封堵术安全、有效，无需体外循环、创伤小，无需X线辅助，住院时间短，使该手术成为更简便、可行、成功率更高的封堵方法，值得临床广泛推广应用。

先天性心脏病介入治疗48例

目的 总结对先天性心脏病患者行介入治疗的临床经验，以提高介入治疗的成功率。 方法 48例先天性心脏病患者采用Cardiacure-TM封堵器行介入治疗，其中房间隔缺损（ASD）21例，动脉导管未闭（PDA）12例，室间隔缺损（VSD）12例，ASD合并PDA 1例，VSD合并PDA 2例。 结果 全组患者无死亡，一次性封堵成功44例，介入封堵治疗成功率为91.7％（44/48）;15例次 PDA患者介入封堵治疗成功率为100％（15/15）; 22例次ASD患者成功率为90.9%（20/22）, 14例次VSD患者成功率为85.7％（12/14）。 封堵伞于术中脱落3例，其中ASD伞脱落2例，VSD伞脱落1例；介入治疗未成功1例。4例封堵未成功的患者中3例择期行体外循环修补手术治愈，1例行急诊体外循环修补手术治愈。随访40例，随访时间1~19个月，复查心脏杂音消失，心脏彩色超声心动图提示无残余分流。 结论 介入治疗是治疗先天性心脏病的有效方法，心胸外科医师掌握该项技术有其较多的优势。

食管超声心动图监测下经胸微创房间隔缺损封堵术

目的评价经食管超声心动图（TEE）监测经胸微创房间隔缺损（ASD）封堵术的临床价值。方法本组16例ASD患者术前均经胸超声心动图检查粗筛，符合封堵条件后在全身麻醉下插入经食管超声探头，于手术开始前，根据ASD最大直径选择合适的封堵器。在手术开始后，监测整个封堵过程，引导封堵伞的放置，评价即刻封堵效果，确认是否有残余分流或并发症。结果16例患者中15例封堵成功，TEE显示封堵器与ASD边缘吻合紧密，无残余分流；1例直径31mm的ASD患者，封堵器放置后发现其后下缘存在残余分流，随即改行体外循环ASD修补术。随访3个月，效果满意。结论TEE对选择适合行封堵术的的ASD患者、选择封堵器大小、指导封堵器的释放、以及疗效评价均具有重要的作用。

经胸微创封堵房间隔缺损术后并发症研究

目的:总结对继发孔型房间隔缺损微创封堵治疗术后并发症监护治疗的经验。方法:6例继发孔型房间隔缺损心脏病患者均采用经由胸小切口,直视超声引导下置入CardiacureTM封堵器。结果:全组患者无死亡,5例1次封堵成功,1例术后2h发现封堵伞脱落,立即给予2次开胸封堵。1例术后出现频发室性多源早搏,伴短阵室速。1例由术前的不完全右束支传导阻滞转成完全右束支传导阻滞,2例术后有少到中量胸腔积液。结论:虽然微创封堵术手术创伤小,但术后监护有其特殊性,ICU医师应引起重视。

经皮左心耳封堵术治疗心房颤动卒中高危患者二例

卵圆孔未闭与反常栓塞的相关性及其研究进展

查阅近几年来国内外对“卵圆孔未闭（PFO）与反常栓塞”相关性研究的资料，从定义、诊断、定量诊断及治疗等方面简述了PFO，分析了它导致反常栓塞的相关机制及其相关性。通过PFO伴卒中治疗上的对比研究分析封堵治疗与药物治疗的可行性。

经胸微创膜部室间隔缺损封堵术围术期炎症因子的变化

Safety and Efficacy of Perventricular Device Closure of Subarterial Ventricular Septal Defect

ObjectiveTo assess the safety and efficacy of a new surgical strategy, perventricular device closure, for the treatment of subarterial ventricular septal defect (VSD). MethodsThirty-nine patients younger than 10 years with subarterial VSD who received surgical repair in West China Hospital from November 2010 to May 2012 were included in this study. There were 18 male and 21 female patients with their age of 5.9±3.2 years. Perventricular device closure was performed with eccentric device under the guidance of transesophageal echocardiography (TEE). Residual shunt, valvular regurgitation (including aortic regurgitation)and arrhythmias during perioperative period and follow-up were analyzed. ResultsThirty-three patients successfully received perventricular device closure, and 6 patients received conversion to open surgical repair. Postoperative ICU stay was 2.2±0.8 days, and length of hospital stay was 4.8±1.8 days. Major postoperative complications included residual shunt and mild or less aortic regurgitation. Mean follow-up duration was 7±2 months. No obvious arrhythmia, moderate or severe valvular regurgitation was observed during follow-up. ConclusionPerventricular device closure is safe, efficacious and minimally invasive for the treatment of subarterial VSD in pediatric patients with suitable anatomic characteristics with good mid-term results.

Hybrid Perventricular Closure for Pediatric Patients with Muscular Ventricular Septal Defect: Experience from West China Hospital

ObjectiveTo investigate the efficacy and safety of hybrid perventricular device closure (PVDC) for the treatment of muscular ventricular septal defect (MVSD) in pediatric patients. MethodsWe retrospectively analyzed clinical data of 35 pediatric patients with MVSD who received hybrid PVDC in West China Hospital between 2009 and 2012. There were 16 males and 19 females with their median age of 3.9 years (range, 1 month to 7 years). There were 10 patients with single MVSD, 12 patients with multiple MVSD, 6 patients with other congenital heart defects, and 7 patients with post-surgical residual MVSD. ResultsAmong the 35 patients, immediate complete closure was achieved in 28 (80.0%) patients. Residual shunt was noted in 7 (20.0%) patients. Median device size was 5 mm. Cardiopulmonary bypass was avoided in 19 patients. Two (5.7%) patients died postoperatively due to postoperative heart failure resulted from complex congenital heart defect. All survival patients were followed up for a mean duration of 6 months, and there was no late death. Thirty-one (93.9%) patients had good positioning of the closure devices but no residual shunt. Small residual shunt at the apex was noted in 2 (6.1%) patients. ConclusionHybrid PVDC is an effective treatment for MVSD with relatively high successful rate but low mortality and morbidity, and its short-term results are satisfactory.

Per-ventricular Device Closure of Doubly Committed Sub-arterial Ventricular Septal Defect ——Technical Consideration and Perioperative Management

Doubly committed sub-arterial ventricular septal defect (VSD) is a unique type of VSD which is located beneath both the aortic and pulmonary valve. Open-heart repair is traumatic especially for pediatric patient while trans-catheter device closure is also not suitable for this type of VSD. Minimally invasive per-ventricular device closure has been introduced as an alternative method in the treatment of doubly committed VSD with encouraging results. In the review, we will illustrate the surgical technique as well as perioperative management strategy as for this technique in treating doubly committed VSD.