Interventional Treatment of Muscular Ventricular Septal Defect in Children
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摘要:
目的 探讨应用Cardi-O-Fix Plug封堵器治疗儿童肌部室间隔缺损（muscular ventricle septal defect，mVSD）的有效性和安全性。 方法 将昆明医科大学第一附属医院从2015年7月至2021年6月心内科收治的14例mVSD患儿作为研究对象。分为实验组（14例）和对照组（10例），实验组采用Cardi-O-Fix Plug封堵器进行封堵，对照组采用Cardi-O-Fix mVSD封堵器进行封堵。术后1d以及随访1个月、3个月、6个月采用经胸超声心动图和心电图评价封堵疗效及并发症的发生情况。 结果 24例患儿中22 例成功封堵，2例封堵失败（实验组和对照组各1例），实验组成功率92.8%（13/14），对照组成功率90.0%（9/10）。实验组的平均手术时长（71.93±14.85）min，对照组的平均手术时间时长（90.70±19.78）min，二者比较差异有统计学意义（P < 0.05）。实验组和对照组在术中及随访期间均未出现严重并发症。比较不同时间点2组的心脏超声指标（包括左室射血分数、左室舒张末期内径以及肺动脉压），差异均无统计学意义（ P > 0.05）。 结论 采用Cardi-O-Fix Plug封堵器在经皮导管封堵心尖部及小梁部的儿童mVSD手术安全有效，短期及中长期发生心律失常的概率低。 Abstract:Objects To explore the effectiveness and safety of using the Cardio-O-Fix Plug occluder in the treatment of muscular ventricular septal defect（mVSD） in children. Methods 14 patients with mVSD were taken to the cardiology department of First Affiliated Hospital of Kunming Medical University from July 2015 to June 2021 as research subjects. They were divided into two groups: 14 children who received Cardi-O-Fix Plug occluder as the experimental group, and 10 children who received Cardi-O-O-Fix mVSD occluder as the control group. Electrocardiogram and transthoracic echocardiography were used to evaluate the occlusive efficacy and incidence of complications 1 day after surgery and 1 month, 3 months, and 6 months of follow-up. Results Among the 24 pediatric patients, 22 cases were successfully occluded, and 2 cases were unsuccessful（1 in the experimental group and 1 in the control group）. The success rate of the experimental group was 92.8%（13/14）, while the success rate of the control group was 90.0%（9/10）. The average surgical duration of the experimental group was（71.93 ± 14.85） minutes, while the average surgical duration of the control group was（90.70 ± 19.78） minutes. There was a significant statistical difference between the two groups（P < 0.05）. Both the experimental group and the control group did not experience serious complications during surgery and follow-up. There was no significant difference in cardiac ultrasound indicators（including left ventricular ejection fraction, left ventricular end-diastolic diameter, and pulmonary artery pressure） between the two groups at different time points（ P > 0.05）. Conclusion Transcatheter closure of mVSD using Cardi-O-Fix Plug occluder in children is both safe and effective. The incidence of arrhythmia is low in the short, medium and long term. -
Key words:
- Ventricular septal defect /
- Muscule /
- Occluder /
- Domestic /
- Percutaneous intervention /
- Congenital heart disease /
- Children
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表 1 2组患儿的基本信息[（ $\bar x\pm s$）/M（P25，P75）]
Table 1. General information of two groups of children [（ $\bar x\pm s$）/M（P25，P75）]
项目 对照组（n = 10） 实验组（n = 14） t/z P 年龄（岁） 6.92 ± 5.17 6.21 ± 3.45 −0.380 0.709 体重（kg） 18.85[12.68，44.28] 17.75[15.98，21.08] −0.088 0.930 左室面大小（cm） 0.69 ± 0.13 0.57 ± 0.14 −2.057 0.052 右室面大小（cm） 0.47 ± 0.13 0.37 ± 0.12 −1.941 0.065 
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表 2 2组患儿手术时长及成功率的对比[（ $\bar x\pm s $）/n（%）]
Table 2. Comparison of surgical duration and success rate between two groups of pediatric patients [（ $\bar x\pm s $）/n（%）]
类别 对照组（n = 10） 实验组（n = 14） t P 手术成功率 9（90.0） 13（92.8） − 1.000 手术时长（min） 90.70 ± 19.78 71.93 ± 14.85 −2.661 0.014* *P < 0.05。
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表 3 不同时间点2组患儿心脏超声指标的比较（ $\bar x\pm s $）
Table 3. Comparison of cardiac ultrasound indicators between two groups of pediatric patients at different time points（ $\bar x\pm s $）
时间 心超结果 对照组（n = 9） 实验组（n = 13） t P 术后1d 左室射血分数（%） 60.11 ± 5.67 59.00 ± 3.14 −0.592 0.561 左室舒张末期内径（mm） 35.22 ± 7.61 31.00 ± 3.65 −1.744 0.097 肺动脉压（mmHg） 28.78 ± 2.91 27.77 ± 2.71 −0.980 0.415 术后1月 左室射血分数（%） 58.89 ± 5.01 59.31 ± 3.17 0.241 0.812 左室舒张末期内径（mm） 34.00 ± 7.00 30.62 ± 3.62 −1.490 0.152 肺动脉压（mmHg） 27.67 ± 3.32 26.31 ± 2.56 −1.085 0.291 术后6月 左室射血分数（%） 58.78 ± 3.99 59.62 ± 2.90 0.571 0.574 左室舒张末期内径（mm） 32.33 ± 3.50 30.23 ± 2.83 −1.556 0.135 肺动脉压（mmHg） 28.11 ± 3.69 26.08 ± 2.69 −1.499 0.149
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表 4 2组并发症的比较[n（%）]
Table 4. Comparison of complications between two groups [n（%）]
项目 实验组（n = 13） 对照组（n = 9） χ2 P 心律失常 1（7.69） 3（33.3） 2.350 0.264 残余分流 1（7.69） 2（22.2） 0.953 0.544 瓣膜返流 0 4（44.4） 7.062 0.017* *P < 0.05。
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[1] Rao P S,Harris A D. Recent advances in managing septal defects: ventricular septal defects and atrioventricular septal defects[J]. F,1000,Res,2018,26(7):482-498. [2] Miyake T. A defect septal ventricular muscular review of isolated[J]. World J Pediatr,2020,16(2):120-128. doi: 10.1007/s12519-019-00289-5 [3] 李博宁,刘琮,欧振恒,等. 小儿肌部室间隔缺损介入治疗分析[J]. 中国介入心脏病学杂志,2021,29(10):589-591. doi: 10.3969/j.issn.1004-8812.2021.10.009 [4] 张力,张金盈. 儿童肌部室间隔缺损介入治疗效果分析[J]. 郑州大学学报(医学版),2017,52(4):504-507. [5] Thanopoulos B D. Catheter closure of congenital muscular ventricular septal defects[J]. Pediatr Cardiol,2005,26(3):220-223. doi: 10.1007/s00246-005-1004-6 [6] Chowdhury U K,Anderson R H,Spicer D E,et al. A review of the therapeutic managementof multiple ventricular septal defects[J]. J Card Surg,2022,37(5):1361-1376. doi: 10.1111/jocs.16289 [7] Maddali M M,Al-Maskari S N,Kandachar P S,et al. Transesophageal echocardiography-assisted transcatheter device closure of apical muscular ventricular septal defect[J]. Saudi J Anaesth,2019,13(2):148-150. doi: 10.4103/sja.SJA_625_18 [8] Lock J E,Block P C,McKay R G,et al. Transcatheter closure of ventricular septal defects[J]. Circulation,1988,78(2):361-368. [9] Pedra C A,Pedra S R,Chaccur P,et al. Perventricular device closure of congenital muscular ventricular septal defects[J]. Expert Rev Cardiovasc Ther,2010,8(5):663-674. doi: 10.1586/erc.10.31 [10] Patel H T,Hijazi Z M. Pediatric catheter interventions: a year in review 2004-2005[J]. Curr Opin Pediatr,2005,17(5):568-573. doi: 10.1097/01.mop.0000172813.56766.52 [11] 刘锦纷. 先天性心脏病镶嵌治疗的若干问题[J]. 中华外科杂志,2007,45(12):798-800. doi: 10.3760/j.issn:0529-5815.2007.12.002 [12] 陈捷,傅立军,杜军保. 《儿童常见先天性心脏病介入治疗专家共识》解读[J]. 中国医刊,2015,50(5):22-25. doi: 10.3969/j.issn.1008-1070.2015.05.007 [13] Song J. Percutaneous transcatheter closure of congenital ventricular septal defects[J]. Korean Circ J,2023,53(3):134-150. doi: 10.4070/kcj.2022.0336 [14] Chen Z,Yu Z,Su L,et al. Transcatheter closure of muscular ventricular septal defects using the Cardi-O-Fix plug[J]. Cardiol Young,2021,31(9):1472-1475. doi: 10.1017/S1047951121000482 [15] 韦丹妮,韩咏,雷先强,等. 经皮介入封堵治疗小儿心尖部肌部室间隔缺损2例[J]. 岭南心血管病杂志,2020,26(1):98-99. doi: 10.3969/j.issn.1007-9688.2020.01.23 -
