Kang Sok Leng, Tometzki Andrew, Caputo Massimo, Morgan Gareth, Parry Andrew, Martin Robin
Bristol Congenital Heart Centre, Bristol Royal Hospital for Children and Bristol Royal Infirmary, University Hospitals Bristol, NHS Foundation Trust, Bristol, United Kingdom.
Catheter Cardiovasc Interv. 2015 May;85(6):998-1005. doi: 10.1002/ccd.25821. Epub 2015 Feb 3.
To describe the longer-term clinical experience and follow-up with perventricular device closure of ventricular septal defects (VSD) in children.
Between January 2005 and December 2013, muscular ventricular septal defect closure with the Amplatzer Muscular VSD Occluder was undertaken using a hybrid perventricular approach. Data including demographic, echocardiographic parameter, and clinical outcome were reviewed retrospectively.
Median age at the time of procedure was 8.9 months (range 1.9-31.0 months) and median weight was 6.6 kg (range 4.5-12.9 kg). All had a moderate to large muscular VSD, three had more than one VSD, four had previous coarctation repair, and five had previous pulmonary artery (PA) banding. A single Amplatzer muscular occluder (range 8-18 mm) was deployed in each patient without cardiopulmonary bypass under echocardiographic guidance. Two of ten patients subsequently required a short period of cardiopulmonary bypass for reconstruction of PA after de-banding and closure of atrial septal defect in one. Occluder removal was necessary in one patient due to entrapment of the tricuspid valve and progressive tricuspid regurgitation. This patient underwent surgical repair with a good result and no device-related valve damage. In the remaining nine patients, no severe complications such as device embolization, arrhythmia, or significant valve regurgitation were noted in the post-operative period or follow-up. At a median time of 6.5 years (range 0.9-8.4 years) post device implantation, complete closure was achieved in five patients and four had small residual leaks, which were not hemodynamically significant.
Perventricular muscular VSD closure is effective in small children with suitable muscular defects and may avoid the morbidity associated with cardiopulmonary bypass and conventional surgical repair. There have been no late complications with this approach.
描述儿童室间隔缺损（VSD）经心室周围装置封堵的长期临床经验及随访情况。
2005年1月至2013年12月期间，采用混合心室周围方法，使用Amplatzer肌部室间隔缺损封堵器进行肌部室间隔缺损封堵。回顾性分析包括人口统计学、超声心动图参数和临床结果等数据。
手术时的中位年龄为8.9个月（范围1.9 - 31.0个月），中位体重为6.6千克（范围4.5 - 12.9千克）。所有患者均有中度至大型肌部室间隔缺损，3例有多个室间隔缺损，4例曾行主动脉缩窄修复术，5例曾行肺动脉（PA）环扎术。在超声心动图引导下，每位患者在非体外循环下植入单个Amplatzer肌部封堵器（范围8 - 18毫米）。10例患者中有2例随后因解除PA环扎和封堵房间隔缺损后需要短时间的体外循环来重建PA。1例患者因三尖瓣被困和进行性三尖瓣反流而需要取出封堵器。该患者接受了手术修复，效果良好，且无与装置相关的瓣膜损伤。在其余9例患者中，术后或随访期间未发现严重并发症，如装置栓塞、心律失常或明显的瓣膜反流。在装置植入后的中位时间6.5年（范围0.9 - 8.4年）时，5例患者实现了完全封堵，4例有小的残余分流，血流动力学上无显著意义。
经心室周围肌部室间隔缺损封堵术对有合适肌部缺损的小儿有效，且可避免与体外循环和传统手术修复相关的发病率。该方法无晚期并发症。
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