Nie You-Lin, Lin Ming-Chih, Lin Wei-Wen, Wang Chung-Chi, Chen Ching-Pei, Lin Chia-Hsun, Shyu Tsung-Cheng, Quek Yeak-Wun, Jan Sheng-Ling, Fu Yun-Ching
Division of Pediatric Cardiology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; Department of Pediatrics, National Yang-Ming University, Taipei, Taiwan, ROC.
Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; Department of Life Science, Tunghai University, Taichung, Taiwan, ROC.
J Chin Med Assoc. 2017 Jan;80(1):34-38. doi: 10.1016/j.jcma.2016.02.014. Epub 2016 Nov 23.
Transcatheter device closure of postmyocardial infarction ventricular septal defect (PMIVSD) is less invasive than surgical repair. However, its feasibility, timing, outcome, and prognostic factors remain unclear.
This was a multicenter, retrospective cohort study. Between February 2012 and July 2015, a total of 10 (8 male and 2 female) patients with PMIVSD undergoing attempted device closure were enrolled retrospectively. The procedures were performed under general anesthesia with fluoroscopic and transesophageal echocardiographic guidance.
The patients enrolled in the study were in the age range 50-85 years (median age of 76.5 years). The interval from infarction to device closure ranged from 6-147 days, with the median of 12 days. A total of 13 devices were implanted in 10 patients. There were five Amplatzer muscular ventricular septal defect occluders, four Amplatzer septal occluders, three Amplatzer PMIVSD occluders and one Amplatzer vascular plug II. Complications included transient ventricular tachycardia in three patients, device embolization in one patient, and tracheal bleeding in one patient. No procedure-related death, stroke, or cardiac tamponade was noted. During follow-up, two patients died of heart failure and two patients died of sepsis. Overall, subjects with age ≥ 80 years, systolic blood pressure ≤ 90 mmHg, and procedure time ≥180 minutes were significant predictor factors for mortality. All patients with the interval of infarction to device closure >12 days survived.
Our findings indicate that transcatheter device closure of PMIVSD is technically feasible, safe, and effective to reduce the shunt. The crucial prognostic factors were ascertained to be age ≥ 80 years, systolic blood pressure ≤ 90 mmHg, and procedure time ≥180 minutes.
经导管装置封堵心肌梗死后室间隔缺损（PMIVSD）比外科修复侵入性小。然而，其可行性、时机、结果和预后因素仍不清楚。
这是一项多中心回顾性队列研究。2012年2月至2015年7月，共回顾性纳入了10例（8例男性和2例女性）尝试进行装置封堵的PMIVSD患者。手术在全身麻醉下，在荧光透视和经食管超声心动图引导下进行。
纳入研究的患者年龄在50 - 85岁之间（中位年龄76.5岁）。从梗死到装置封堵的间隔时间为6 - 147天，中位时间为12天。共对10例患者植入了13个装置。其中有5个Amplatzer肌部室间隔缺损封堵器、4个Amplatzer房间隔封堵器、3个Amplatzer PMIVSD封堵器和1个Amplatzer血管塞II。并发症包括3例患者出现短暂性室性心动过速、1例患者装置栓塞和1例患者气管出血。未观察到与手术相关的死亡、中风或心脏压塞。随访期间，2例患者死于心力衰竭，2例患者死于败血症。总体而言，年龄≥80岁、收缩压≤90 mmHg和手术时间≥180分钟的受试者是死亡显著预测因素。梗死到装置封堵间隔时间>12天的所有患者均存活。
我们的研究结果表明，经导管装置封堵PMIVSD在技术上是可行的、安全的，并且对于减少分流是有效的。确定的关键预后因素为年龄≥80岁、收缩压≤90 mmHg和手术时间≥180分钟。
