摘要
目的探讨降低房室间隔缺损介入治疗失败后外科手术病死率的有效措施。方法对16例房间隔缺损（ASD）和室间隔缺损（VSD）介入治疗失败需外科手术患者的临床资料进行回顾性分析。手术均在体外循环下进行，取出封堵器，修复心内畸形。结果本组无外科手术死亡病例。ASD部位为中央型5例，下腔型7例，与术前诊断相符率41．7％（5／12），不相符率58．3％（7／12）（P〉0．05）。术后ASD直径平均（31．0±1．0）mm，较术前诊断的（26．0±2_3）mm增大（P〈0．05）。术后VSD直径平均（5．0±0．8）mm，与术前诊断的（4．0±0．3）mm比较差异无统计学意义（P〉0．05）。3例第三度房室传导阻滞术后均恢复窦性心律，心内畸形修复完善。结论房室间隔缺损介入治疗后发生严重并发症及时采取外科手术治疗，可提高手术成功率。
Objective To probe the effective measures for decreasing the early mortality after unsuccessful interventional treatment for atrial septal defect （ASD） and ventricular septal defect （VSD）. Methods A total of 16 patients who underwent surgical treatment of unsuccessful interventional treatment for ASD and VSD from January 2000 to December 2007 were included in this retrospective analysis. Surgical indication was the occluder abscission （7 cases）, cardiac perforation（3 cases）, the third degree atrioventricular conduction block （3 cases）,valvular regurgitation （2 eases, 1 case accompanied with the third degree atrioventricular conduction block）, residual shunt （ 1 case）, unsuccessful interventional treatment （ 1 case ）. All of 16 cases underwent surgical treatment including removal of the displaced oceluder and/or the congenital heart disease repaired,on cardiopulmonary bypass. After surgical treatment, all patients were transferred into ICU for further supervision and treatment. Results There was no hospital mortality. Twelve ASD eases were performed after the interventional treatment, which included 5 cases with central ASD and 7 cases with inferior sinus venous ASD. Coincidental rate between operating exploration and preoperative diagnosis was 41.7% （5/12）. Misdiagnostic rate between them was 58.3% （7/12）. The diameter of ASD （31.0 ± 1.0） mm by operating exploration after interventional therapy of ASD obviously increased compared with that （26.0 ± 2.3 ） mm before preoperative diagnosis （P 〈 0.05 ）. The diameter of VSD（5.0 ± 0.8 ） mm by operating exploration after interventional therapy of VSD obviously increased compared with that （4.0±0.3 ） mm before operative diagnosis （P 〉 0.05 ）. The third degree atrioventricular conduction block （3 cases） restored sinus rhythm after operation. Procedure was successful in all patients. Conclusion It is necessary to monitor severe complications of unsuccessful interventional treatment for ASD and VSD to assure the successes of the operations.
出处
《中国医师进修杂志》
2010年第2期4-6,共3页
Chinese Journal of Postgraduates of Medicine
关键词
房间隔缺损
室间隔缺损
死亡率
介入封堵
Heart septal defects,atrial
Heart septal defects,ventricular
Mortality
Transcatheter closu
