Chen Shao-ping, Bai Yuan, Zhao Xian-xian, Qin Yong-wen
Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2012 Apr;40(4):298-301.
To evaluate the safety and efficacy of transcatheter closure of ruptured aneurysm of the sinus of Valsalva (RAVS) using a domestic made small-waist ventricular septal defect occluder.
Between September 2005 and December 2010, transcatheter closure of RAVS was randomly performed in 7 patients of (43.5 ± 13.0) years old using domestic made small-waist ventricular septal defect occluder in our department. RAVS was diagnosed by color Doppler echocardiography. The size of the small-waist double-disk occlude selected was 4 to 6 mm larger than the narrowest diameter of the opening of aneurysm. After establishment of the arteriovenous wire loop, the device was deployed by retrograde venous approach in all patients. All patients were followed up in terms of rhythm change, residual shunt, shape of occlude, and possible valve regurgitation by echocardiography for 6 to 12 months.
All RAVS were confirmed by aortography. Aortography showed rupture of right coronary sinus into the right ventricle in 6 patients and non-coronary sinus ruptured into right ventricle in another patient. The estimated size of the defect was 4 to 7 (5.0 ± 1.3) mm by aortogram. Ventricular septal defect was evidenced in 2 patients. All defects were successfully occluded without complication. Two patients with ventricular septal defect received combined percutaneous ventricular septal defect closure. After transcatheter RAVS occlusion, pulmonary artery systolic pressure decreased from (35.6 ± 12.7) mm Hg (1 mm Hg = 0.133 kPa) to (27.4 ± 6.2) mm Hg (P < 0.05), and mean pulmonary artery pressure decreased from (21.9 ± 8.0) mm Hg to (16.1 ± 5.3) mm Hg (P < 0.05). Cardiac murmur disappeared right after successful occlusion. Echocardiography detected a trace of residual shunt in one patient after occlusion which disappeared the next day. There was no aortic regurgitation, hemolysis and arrhythmia during hospitalization. There was no device embolization, infective endocarditis, right heart failure and death during the 6 to 12 months follow-up.
Transcatheter closure of RAVS with the domestic made small-waist ventricular septal defect occluder is safe and effective.
评估使用国产小腰型室间隔缺损封堵器经导管封堵瓦氏窦瘤破裂（RAVS）的安全性和有效性。
2005年9月至2010年12月，我科对7例年龄为（43.5±13.0）岁的RAVS患者，随机采用国产小腰型室间隔缺损封堵器经导管进行封堵。通过彩色多普勒超声心动图诊断RAVS。所选小腰型双盘封堵器的尺寸比瘤体开口最窄直径大4至6毫米。在建立动静脉导丝环后，所有患者均经逆行静脉途径释放封堵器。所有患者均通过超声心动图对心律变化、残余分流、封堵器形态及可能出现的瓣膜反流进行了6至12个月的随访。
所有RAVS均经主动脉造影证实。主动脉造影显示，6例患者为右冠状动脉窦破裂入右心室，另1例患者为无冠状动脉窦破裂入右心室。主动脉造影显示缺损大小为4至7（5.0±1.3）毫米。2例患者存在室间隔缺损。所有缺损均成功封堵，无并发症发生。2例合并室间隔缺损的患者接受了经皮室间隔缺损封堵术。经导管封堵RAVS后，肺动脉收缩压从（35.6±12.7）毫米汞柱（1毫米汞柱 = 0.133千帕）降至（27.4±6.2）毫米汞柱（P < 0.05），平均肺动脉压从（21.9±8.0）毫米汞柱降至（16.1±5.3）毫米汞柱（P < 0.05）。封堵成功后心脏杂音立即消失。超声心动图检查发现1例患者封堵后有微量残余分流，次日消失。住院期间无主动脉瓣反流、溶血及心律失常发生。随访6至12个月期间无封堵器栓塞、感染性心内膜炎、右心衰竭及死亡发生。
使用国产小腰型室间隔缺损封堵器经导管封堵RAVS安全有效。
