Pedra Carlos A C, Pedra Simone R F, Esteves Cesar A, Pontes Sérgio C, Braga Sérgio L N, Arrieta S Raul, Santana M Virgínia T, Fontes Valmir F, Masura Jozef
Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
Catheter Cardiovasc Interv. 2004 Mar;61(3):403-10. doi: 10.1002/ccd.10797.
Percutaneous closure of perimembranous ventricular septal defects (VSDs) has been feasible, safe, and effective with the new Amplatzer membranous septal occluder. We report further experience with this device with emphasis on morphological aspects of the VSDs and technical issues. Ten patients (median age and weight, 14 years and 34.5 kg, respectively) with volume-overloaded left ventricles underwent closure under general anesthesia and transesophageal guidance (TEE). The VSD diameter was 7.1 +/- 4.0 mm by angiography and 7.8 +/- 3.7 mm by TEE. Three patients had defects associated with aneurysm-like formations (two with multiple exit holes), four had defects shrouded by extensive tricuspid valve tissue, two had defects with little or no tricuspid valve involvement, and one had a right aortic cusp prolapse with trivial aortic regurgitation. Implantation was successful in all patients, although in two the initial device had to be changed for a larger one. Kinkings in the delivery sheath, inability to position the sheath near the left ventricular apex, and device prolapse through the VSD prompted modifications in the standard technique of implantation. Device orientation was excellent except in one case. Nine patients had complete occlusion within 1-3 months. Device-related aortic or tricuspid insufficiency, arrhythmias, and embolization were not observed. Two patients had slight gradients across the left ventricular outflow tract, normalizing after 3 months. The Amplatzer membranous septal occluder was suitable to close a wide range of perimembranous VSD sizes and morphologies with good short-term outcomes. Longer follow-up is required.
使用新型Amplatzer膜周部室间隔缺损封堵器经皮闭合膜周部室间隔缺损（VSD）已切实可行、安全且有效。我们报告了使用该装置的更多经验，重点关注VSD的形态学方面和技术问题。10例左心室容量负荷过重的患者在全身麻醉和经食管超声心动图（TEE）引导下接受了封堵治疗。这些患者的中位年龄和体重分别为14岁和34.5千克。血管造影显示VSD直径为7.1±4.0毫米，TEE显示为7.8±3.7毫米。3例患者的缺损伴有瘤样形成（2例有多个出口孔），4例患者的缺损被广泛的三尖瓣组织覆盖，2例患者的缺损几乎没有或仅有少量三尖瓣受累，1例患者有右主动脉瓣叶脱垂伴轻度主动脉瓣反流。所有患者植入均成功，不过有2例最初的装置不得不更换为更大尺寸的。输送鞘管出现扭结、无法将鞘管放置在左心室心尖附近以及装置通过VSD脱垂促使我们对标准植入技术进行了改进。除1例患者外，装置定位均良好。9例患者在1至3个月内实现完全封堵。未观察到与装置相关的主动脉瓣或三尖瓣关闭不全、心律失常及栓塞情况。2例患者左心室流出道存在轻微压差，3个月后恢复正常。Amplatzer膜周部室间隔缺损封堵器适用于闭合各种大小和形态的膜周部VSD，短期效果良好。仍需进行更长时间的随访。
