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目的总结分析应用第二代动脉导管未闭封堵器(ADO-Ⅱ)对特殊类型室间隔缺损(VSD)封堵的技巧。方法研究对象为2011年8月至9月在上海交通大学医学院附属上海儿童医学中心行介入治疗的患儿2例,因应用常规VSD封堵器封堵困难,遂选取ADO-Ⅱ进行治疗。常规建立动静脉轨迹后,采用主动脉内释放,然后行左室、升主动脉造影和心脏超声检查,如封堵器位置好,无残余分流、瓣膜反流则释放。结果例1左室造影显示为膜周VSD,左室面7.6mm,较大假性室隔瘤形成,右室分流口弥散,最大约2.3mm,缺损上缘距主动脉为6.1mm。导丝建轨后,7F长鞘无法通过分流口,最后选用5F长鞘,“6mm×4mm”的ADO-Ⅱ封堵成功,术后心脏超声三尖瓣轻微分流。例2心室造影为肌部VSD,左室面6.3mm,右室分流口为2mm,上缘距主动脉16mm。因VSD走行异常且分流口小,最终选冠脉导丝建轨成功,应用4F长鞘,“4mm×4mm”ADO-Ⅱ封堵成功。2例患儿术后1d复查心脏超声和心电图,无异常,观察5d后出院随访,并口服阿司匹林[3～5mg(/kg·d)]。结论对于一些形态较特殊的VSD,常规VSD封堵器无法成功封堵时,可选择ADO-Ⅱ进行封堵,手术操作简单、安全、可靠而并发症少。
Objective To summarize and analyze the technique of occlusion of special type ventricular septal defect (VSD) with second-generation patent ductus arteriosus occluder (ADO-Ⅱ). Methods Totally 2 children underwent PCI in Shanghai Children’s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine from August to September in 2011. ADO-Ⅱ was selected for treatment due to the difficulty of occluding conventional VSD occluder. Conventional establishment of arteriovenous trajectory, the use of intra-aortic release, and then left ventricle, ascending aorta angiography and echocardiography, such as the location of the occluder, no residual shunt, valvular regurgitation was released. Results of Example 1 left ventricular angiography showed VSD, left ventricular surface 7.6mm, larger pseudocapillary tumor formation, diffuse right ventricular diffuser, the maximum about 2.3mm, the defect margin from the aorta to 6.1mm. After the guide rail is built, the 7F long sheath can not pass the shunt port, and the final selection of 5F long sheath, “6mm × 4mm” ADO-Ⅱ successful occlusion, postoperative cardiac tricuspid valve tributary slightly shunt. Example 2 ventriculography myofascial VSD, left ventricular surface 6.3mm, right ventricular shunt 2mm, the upper edge of the aorta 16mm. Due to the abnormal walking of VSD and the small shunt, the successful selection of coronary artery guide rail, using 4F long sheath, “4mm × 4mm” ADO-Ⅱ successful closure. Two cases of children underwent echocardiography and electrocardiogram at 1 day after operation. No abnormalities were observed. The patients were followed up for 5 days and aspirin [3-5 mg (/ kg · d)] was given orally. Conclusion For some VSDs with special shape, ADO-Ⅱ can be choosed when conventional VSD occluder can not be blocked. The operation is simple, safe, reliable and the complication is less.