Fouilloux Virginie, Bonello Béatrice, Gran Célia, Fraisse Alain, Macé Loïc, Kreitmann Bernard
Department of Thoracic and Cardio-Vascular Surgery, Hôpital d'enfants de la Timone, Marseille, France.
World J Pediatr Congenit Heart Surg. 2012 Oct 1;3(4):446-51. doi: 10.1177/2150135112447958.
To report our experience with perventricular closure of muscular (apical) ventricular septal defects (VSDs) in small infants, with echocardiographic guidance only, in a nonhybrid suite.
Eight infants with nine large muscular (apical) VSDs underwent perventricular device closure in a nonhybrid operating room, with transesophageal and epicardial echocardiography guidance, at a mean age and weight of 3.07 (0.3-7.28) months and 3.7 (2.5-6.2) kg, respectively. Five patients had multiple VSDs. Four had associated cardiac defects.
Nine Amplatzer muscular VSD devices with a mean size of 10 (4-14) mm were deployed. Seven patients were discharged from the intensive care unit with a mean length of stay of 8.6 days. Four patients had minimal postprocedural residual shunt; no one had a residual shunt at six-month follow-up. Mid-term results are excellent.
Perventricular closure is feasible under echocardiographic guidance only in small patients, even without hybrid suite. This may be a good approach for very symptomatic low-weight infants with apical VSD and may also be useful, in any center, at any time, and in any operating room, to treat an associated apical VSD, even unexpected.
报告我们仅在超声心动图引导下，于非杂交手术室对小婴儿进行室间隔肌部（心尖部）室间隔缺损（VSD）经室周封堵的经验。
8例患有9个大型室间隔肌部（心尖部）VSD的婴儿在非杂交手术室接受经室周装置封堵，术中采用经食管和心外膜超声心动图引导，平均年龄和体重分别为3.07（0.3 - 7.28）个月和3.7（2.5 - 6.2）kg。5例患者有多个VSD。4例有相关心脏缺陷。
植入了9个平均尺寸为10（4 - 14）mm的Amplatzer肌部VSD封堵器。7例患者从重症监护病房出院，平均住院时间为8.6天。4例患者术后残余分流极小；6个月随访时无1例有残余分流。中期结果良好。
仅在超声心动图引导下，即使没有杂交手术室，对小患者进行经室周封堵也是可行的。对于有症状的低体重心尖部VSD婴儿，这可能是一种很好的方法，并且在任何中心、任何时间、任何手术室，对于治疗相关的心尖部VSD（即使是意外发现的）也可能有用。
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