Anil S R, Sreekanth Raghavan, Bhalerao Sanjay, Nagarajan R, Agarwal Rohit, Girish N B
Department of Pediatric Cardiology, Apollo Children's Heart Hospital, Hyderabad.
Indian Heart J. 2005 Nov-Dec;57(6):698-703.
Use of trancatheter device closure for membranous ventricular septal defect is still in evolving phase. We report the early and mid-term results of our experience with the new asymmetric Amplatzer membranous ventricular septal defect occluder.
We attempted, transcatheter closure of perimembranous ventricular septal defect using asymmetric Amplatzer occluder in 26 patients. The patients were selected on the basis of transthoracic and transesophageal echocardiographic assessment of the ventricular septal defect. The procedure was successful in 21 (81%) patients. The age ranged from 3 to 23 years, weight from 10 to 59 kg and defect size ranged from 3 to 9 mm (mean: 5 +/- 1.8 mm). One patient had situs inversus with dextrocardia: 11 had aneurysmal tissue partly occluding the defect and the device was deployed either across (n=6) or within the aneurysmal sac (n=5). Three patients developed high degree atrioventricular block on attempts to cross the defect with the sheath and the procedure was discontinued. In two patients it was not possible to place the sheath in left ventricle despite repeated attempts. There was a residual flow in 4 (19%) patients at 24 hours. Two patients developed bundle branch block and none had complete heart block. At follow-up (1-9 months, n=20), residual flow was seen in two patients. None developed late conduction defect, aortic regurgitation, infective endocarditis or hemolysis.
Transcatheter closure of perimembranous ventricular septal defect can be performed safely and effectively with the new asymmetric Amplatzer occluder device in selected patients with good short- and midterm results. These devices can be deployed safely in and across and the aneurysmal sacs. In selected cases, this procedure is a satisfactory alternative to surgery.
经导管装置封堵膜周部室间隔缺损仍处于发展阶段。我们报告了使用新型不对称Amplatzer膜周部室间隔缺损封堵器的早期和中期经验结果。
我们尝试使用不对称Amplatzer封堵器对26例患者进行经导管膜周部室间隔缺损封堵术。患者根据经胸和经食管超声心动图对室间隔缺损的评估进行选择。21例（81%）患者手术成功。年龄范围为3至23岁，体重为10至59千克，缺损大小为3至9毫米（平均：5±1.8毫米）。1例患者为镜面右位心伴右旋心；11例有瘤样组织部分封堵缺损，封堵器置于瘤样组织两侧（n = 6）或瘤样组织囊内（n = 5）。3例患者在尝试用鞘管穿过缺损时发生高度房室传导阻滞，手术终止。尽管反复尝试，仍有2例患者无法将鞘管置入左心室。4例（19%）患者术后24小时有残余分流。2例患者发生束支传导阻滞，无1例发生完全性心脏传导阻滞。随访（1至9个月，n = 20）时，2例患者有残余分流。无1例发生晚期传导缺陷、主动脉瓣反流、感染性心内膜炎或溶血。
对于选定的患者，使用新型不对称Amplatzer封堵器经导管封堵膜周部室间隔缺损安全有效，短期和中期结果良好。这些封堵器可安全地置于瘤样组织两侧或瘤样组织囊内。在某些情况下，该手术是手术的一种令人满意的替代方法。
