王建铭, 王琦光, 孟立立, 庚靖淞, 王忠超, 肖家旺. 应用第二代Amplatzer动脉导管未闭封堵器治疗成人膜周部室间隔缺损疗效分析及中长期随访[J]. 心脏杂志, 2023, 35(2): 150-155. DOI: 10.12125/j.chj.202205025
    引用本文: 王建铭, 王琦光, 孟立立, 庚靖淞, 王忠超, 肖家旺. 应用第二代Amplatzer动脉导管未闭封堵器治疗成人膜周部室间隔缺损疗效分析及中长期随访[J]. 心脏杂志, 2023, 35(2): 150-155. DOI: 10.12125/j.chj.202205025
    Jian-ming WANG, Qi-guang WANG, Li-li MENG, Jing-song GENG, Zhong-chao WANG, Jia-wang XIAO. Middle and long-term follow-up of effectiveness and safety of transcatheter closure of perimembranous ventricular septal defects using Amplatzer duct occluder Ⅱ occluders in adults[J]. Chinese Heart Journal, 2023, 35(2): 150-155. DOI: 10.12125/j.chj.202205025
    Citation: Jian-ming WANG, Qi-guang WANG, Li-li MENG, Jing-song GENG, Zhong-chao WANG, Jia-wang XIAO. Middle and long-term follow-up of effectiveness and safety of transcatheter closure of perimembranous ventricular septal defects using Amplatzer duct occluder Ⅱ occluders in adults[J]. Chinese Heart Journal, 2023, 35(2): 150-155. DOI: 10.12125/j.chj.202205025

    应用第二代Amplatzer动脉导管未闭封堵器治疗成人膜周部室间隔缺损疗效分析及中长期随访

    Middle and long-term follow-up of effectiveness and safety of transcatheter closure of perimembranous ventricular septal defects using Amplatzer duct occluder Ⅱ occluders in adults

    • 摘要:
        目的  分析应用第二代Amplatzer动脉导管未闭封堵器(Amplatzer duct occluder Ⅱ,ADOⅡ)治疗成人膜周部室间隔缺损(perimembranous ventricular septal defect, pmVSD)的安全性、有效性及中长期随访结果。
        方法  根据纳入标准筛选自2013年6月~2021年6月成人pmVSD患者44例,应用ADOⅡ封堵器行室缺封堵术,应用心电图和经胸超声心动图(transthoracic echocardiography , TTE)评价术后即刻、术后 1 日、1月、3月、6月以及每年随访的封堵疗效及并发症发生情况。
        结果  共纳入44例pmVSD患者,年龄(38±13)岁,其中膜部膨出瘤型24例,管型13例,漏斗型4例,pmVSD外科修补术后残余瘘3例。应用ADOⅡ封堵器行pmVSD封堵术,造影下平均缺损出口大小(3.4±1.1)mm,封堵器腰部平均直径(4.8±1.5)mm,封堵器平均长度(4.3±0.7)mm,即刻封堵成功率100%,完全封堵率为75.0%。23例患者随访时间为(38±24)个月,中位随访时间为36个月。与术前相比较,术后6个月随访时,左室EDV从(97±23)mL下降到(86±22)mL (P<0.05),LVEDD从(51±5)mm下降到(46±5)mm (P<0.05),左室射血分数值无显著变化。严重并发症发生率2.3%,随访期间无死亡、感染性心内膜炎、cAVB、封堵器栓塞、需要外科手术治疗的瓣膜反流等严重并发症。心律失常总体发生率为6.8%,术后残余分流即刻发生率为25.0%, 43例患者随访期间心功能均为NYHA Ⅰ级或Ⅱ级。
        结论  经严格筛选的成人pmVSD或外科修补术后残余瘘患者,应用ADOⅡ封堵器行pmVSD封堵术是可行安全的,中长期随访效果良好。

       

      Abstract:
        AIM  To determine the middle and long-term safety and efficacy of using the Amplatzer duct occluder Ⅱ (ADO Ⅱ) for perimembranous ventricular septal defect (pmVSD) closure in adults.
        METHODS  From June 2013 to June 2021, adult pmVSD patients were selected and treated through transcatheter intervention using ADOⅡoccluders. The closure results and complications were evaluated immediately, 1 d, 1 m, 3 m, 6 m and annual follow-up after procedures using electrocardiography and transthoracic echocardiography (TTE).
        RESULTS  A total of 44 patients with pmVSD, aged (38 ± 13) years, were enrolled, including 24 cases of membranous bulging tumor, 13 cases of tubular type, 4 cases of funnel type, and 3 cases of residual fistula after surgical repair of pmVSD. pmVSD occlusion was performed with ADO Ⅱ occluder. Under angiography, the average defect outlet size was (3.4 ± 1.1) mm, the average waist diameter of the occluder was (4.8 ± 1.5) mm, and the average length of the occluder was (4.3 ± 0.7) mm. The success rate of immediate occlusion was 100%, and the complete occlusion rate was 75.0%. The follow-up time of 23 patients was (38 ± 24) months, and the median follow-up time was 36 months. Compared with that before operation, at the 6-month follow-up after operation, the left ventricular EDV decreased from (97 ± 23) mL to (86 ± 22) mL (P<0.05), and the LVEDD decreased from (51 ± 5) mm to (46 ± 5) mm (P<0.05). There was no significant change in the EF value of the left ventricular ejection fraction. The incidence of serious complications was 2.3%. During the follow-up period, there were no deaths, infective endocarditis, cAVB, occluder embolism, valve regurgitation requiring surgical treatment and other serious complications. The overall incidence of arrhythmia was 6.8%, and the immediate residual shunt incidence after operation was 25.0%. The cardiac function of 43 patients during follow-up was NYHA grade I or II.
        CONCLUSION  Transcatheter closure of pmVSD and post-surgery residual shunts using ADO Ⅱ occluders in adults are both safe and effective and yields excellent middle and long-term results in selected patients. The potential benefits of this intervention include remodeling of the heart and reduced incidence of infective endocarditis.

       

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