干下型室间隔缺损内外科治疗的发展演变及研究进展
The Evolution and Research Progress of Surgical and Interventional Treatments for Doubly Committed Subarterial Ventricular Septal Defect
摘要: 干下型室间隔缺损是一种罕见的先天性心脏病，由于其解剖位置特殊，易导致主动脉瓣脱垂和反流，通常需要早期手术干预。文章讨论了以下几种治疗方法：体外循环下外科手术修补：这是干下型室间隔缺损的传统治疗方法，具有高成功率和可靠性，尤其适用于低龄或合并肺动脉高压的患儿。利用封堵器介入关闭：经胸介入、经皮介入手术治疗均不需要体外循环，作为微创的手术方式各有优缺点。还包括其他方法如“镶嵌”概念，本文综述了干下型室间隔缺损的内外科治疗发展演变及研究进展。
Abstract: Doubly committed subarterial ventricular septal defect is a rare congenital heart disease characterized by its unique anatomical location, which predisposes to aortic valve prolapse and regurgitation, often necessitating early surgical intervention. This article discusses several treatment methods: surgical repair under cardiopulmonary bypass, which is the traditional treatment for it, with high success rates and reliability, particularly suitable for young children or those with associated pulmonary hypertension. Interventional closure using occluder devices, both percutaneous and transthoracic approaches, do not require cardiopulmonary bypass and have their respective advantages and disadvantages as minimally invasive surgical methods. The article also includes other approaches such as the “hybrid” concept. This review summarizes the evolution and research progress of surgical and interventional treatments for doubly committed subarterial ventricular septal defect.
文章引用：谭蓓, 李谧. 干下型室间隔缺损内外科治疗的发展演变及研究进展[J]. 临床医学进展, 2025, 15(4): 44-50. https://doi.org/10.12677/acm.2025.154900

参考文献

[1] Eroglu, A.G., Öztunç, F., Saltik, L., Bakari, S., Dedeoglu, S. and Ahunbay, G. (2003) Evolution of Ventricular Septal Defect with Special Reference to Spontaneous Closure Rate, Subaortic Ridge and Aortic Valve Prolapse. Pediatric Cardiology, 24, 31-35. [Google Scholar] [CrossRef] [PubMed]
[2] Starr, A., Menashe, V. and Dotter, C. (1960) Surgical Correction of Aortic Insufficiency Associated with Ventricular Septal Defect. Surgery Gynecology & Obstetrics, 111, 71-76.
[3] Yacoub, M.H., Khan, H., Stavri, G., Shinebourne, E. and Radley-Smith, R. (1997) Anatomic Correction of the Syndrome of Prolapsing Right Coronary Aortic Cusp, Dilatation of the Sinus of Valsalva, and Ventricular Septal Defect. The Journal of Thoracic and Cardiovascular Surgery, 113, 253-261. [Google Scholar] [CrossRef] [PubMed]
[4] Garamella, J.J., Cruz, A.B., Heupel, W.H., Dahl, J.C., Jensen, N.K. and Berman, R. (1960) Ventricular Septal Defect with Aortic Insufficiency: Successful Surgical Correction of Both Defects by the Transaortic Approach. The American Journal of Cardiology, 5, 266-272. [Google Scholar] [CrossRef] [PubMed]
[5] Bonhoeffer, P., Fabbrocini, M., Lecompte, Y., Cifarelli, A., Ballerini, L., Frigiola, A., et al. (1992) Infundibular Septal Defect with Severe Aortic Regurgitation: A New Surgical Approach. The Annals of Thoracic Surgery, 53, 851-853. [Google Scholar] [CrossRef] [PubMed]
[6] Trusler, G.A., Williams, W.G., Smallhorn, J.F. and Freedom, R.M. (1992) Late Results after Repair of Aortic Insufficiency Associated with Ventricular Septal Defect. The Journal of Thoracic and Cardiovascular Surgery, 103, 276-281. [Google Scholar] [CrossRef] 
[7] Chauvaud, S., Serraf, A., Mihaileanu, S., Soyer, R., Blondeau, P., Dubost, C., et al. (1990) Ventricular Septal Defect Associated with Aortic Valve Incompetence: Results of Two Surgical Managements. The Annals of Thoracic Surgery, 49, 875-880. [Google Scholar] [CrossRef] [PubMed]
[8] Ozaki, S., Kawase, I., Yamashita, H., Uchida, S., Nozawa, Y., Matsuyama, T., et al. (2011) Aortic Valve Reconstruction Using Self-Developed Aortic Valve Plasty System in Aortic Valve Disease. Interactive CardioVascular and Thoracic Surgery, 12, 550-553. [Google Scholar] [CrossRef] [PubMed]
[9] Sivalingam, S., Haranal, M. and Pathan, I.H. (2021) Aortic Valve Neocuspidization for Aortic Regurgitation Associated with Ventricular Septal Defect. Interactive CardioVascular and Thoracic Surgery, 34, 315-321. [Google Scholar] [CrossRef] [PubMed]
[10] Devlin, P.J., Russell, H.M., Mongé, M.C., Patel, A., Costello, J.M., Spicer, D.E., et al. (2014) Doubly Committed and Juxtaarterial Ventricular Septal Defect: Outcomes of the Aortic and Pulmonary Valves. The Annals of Thoracic Surgery, 97, 2134-2141. [Google Scholar] [CrossRef] [PubMed]
[11] Hisatomi, K., Taira, A. and Moriyama, Y. (1999) Is Direct Closure Dangerous for Treatment of Doubly Committed Subarterial Ventricular Septal Defect? The Annals of Thoracic Surgery, 67, 756-758. [Google Scholar] [CrossRef] [PubMed]
[12] An, G., Zhang, H., Zheng, S., Wang, W., Wu, Q. and Xing, Q. (2016) Minimally Invasive Surgical Closure for Doubly Committed Subarterial Ventricular Septal Defects through a Right Subaxillary Thoracotomy. Interactive CardioVascular and Thoracic Surgery, 23, 924-928. [Google Scholar] [CrossRef] [PubMed]
[13] Liu, R., Rui, L., Zhang, B., Lin, Y., Li, S. and Hua, Z. (2019) Through Tricuspid Closure for Doubly Committed Subarterial Ventricular Septal Defect with Right Vertical Subaxillary Mini-Incision: A Matched-Pair Analysis. Pediatric Cardiology, 40, 1247-1252. [Google Scholar] [CrossRef] [PubMed]
[14] Wang, G., Liu, R., Ma, K., Zhang, B., Pang, K., Qi, L., et al. (2021) Doubly Committed Subarterial Ventricular Septal Defect Closure through Tricuspid Approach: A Clinical Analysis. Cardiology in the Young, 31, 799-803. [Google Scholar] [CrossRef] [PubMed]
[15] Lock, J.E., Block, P.C., McKay, R.G., Baim, D.S. and Keane, J.F. (1988) Transcatheter Closure of Ventricular Septal Defects. Circulation, 78, 361-368. [Google Scholar] [CrossRef] [PubMed]
[16] 秦永文. 常见先天性心脏病介入治疗中国专家共识二､室间隔缺损介入治疗[J]. 介入放射学杂志, 2011, 20(2): 87-92.
[17] Hijazi, Z.M., Hakim, F., Haweleh, A.A., Madani, A., Tarawna, W., Hiari, A., et al. (2002) Catheter Closure of Perimembranous Ventricular Septal Defects Using the New Amplatzer Membranous VSD Occluder: Initial Clinical Experience. Catheterization and Cardiovascular Interventions, 56, 508-515. [Google Scholar] [CrossRef] [PubMed]
[18] 池菊芳, 郭航远, 彭放, 等. 偏心型封堵器治疗先天性干下型室间隔缺损的探讨[J]. 心脑血管病防治, 2008, 8(1): 8-9, 75.
[19] 邱旭, 冯沅, 干昌平, 等. 应用偏心型封堵器经皮介入治疗干下型室间隔缺损的可行性分析[J]. 华西医学, 2013, 28(6): 848-851.
[20] Shyu, T., Lin, M., Quek, Y., Lin, S., Saw, H., Jan, S., et al. (2017) Initial Experience of Transcatheter Closure of Subarterial VSD with the Amplatzer Duct Occluder. Journal of the Chinese Medical Association, 80, 487-491. [Google Scholar] [CrossRef] [PubMed]
[21] Kuswiyanto, R.B., Rahayuningsih, S.E., Apandi, P.R., Hilmanto, D. and Bashari, M.H. (2021) Transcatheter Closure of Doubly Committed Subarterial Ventricular Septal Defect: Early to One-Year Outcome. International Journal of Cardiology Congenital Heart Disease, 2, Article ID: 100081. [Google Scholar] [CrossRef] 
[22] 赵鹏军, 余志庆, 傅立军, 等. 新型动脉导管未闭封堵器封堵膜周部室间隔缺损的临床应用[J]. 介入放射学杂志, 2011, 20(6): 433-435.
[23] Lin, H., Lin, M., Chen, C., Hsu, J., Lin, S., Wu, M., et al. (2021) Safety and Efficacy of Transcatheter Closure of Outlet-Type Ventricular Septal Defects in Children and Adults with Amplatzer Duct Occluder II. Journal of the Formosan Medical Association, 120, 180-188. [Google Scholar] [CrossRef] [PubMed]
[24] Tang, C., Zhou, K., Shao, S., Liu, X., Li, Y., Hua, Y., et al. (2022) Transfemoral Occlusion of Doubly Committed Subarterial Ventricular Septal Defect Using the Amplatzer Duct Occluder-II in Children. Frontiers in Cardiovascular Medicine, 9, Article 837847. [Google Scholar] [CrossRef] [PubMed]
[25] Bacha, E.A., Cao, Q.-L., Galantowicz, M.E., Cheatham, J.P., Fleishman, C.E., Weinstein, S.W., et al. (2005) Multicenter Experience with Perventricular Device Closure of Muscular Ventricular Septal Defects. Pediatric Cardiology, 26, 169-175. [Google Scholar] [CrossRef] [PubMed]
[26] Kamra, K., Russell, I. and Miller‐Hance, W.C. (2011) Role of Transesophageal Echocardiography in the Management of Pediatric Patients with Congenital Heart Disease. Pediatric Anesthesia, 21, 479-493. [Google Scholar] [CrossRef] [PubMed]
[27] 中国医师协会心血管外科医师分会. 经胸微创室间隔缺损封堵术中国专家共识[J]. 中华胸心血管外科杂志, 2011, 27(9): 516-518.
[28] Chen, Q., Chen, L., Wang, Q., Cao, H., Zhang, G. and Chen, D. (2010) Intraoperative Device Closure of Doubly Committed Subarterial Ventricular Septal Defects: Initial Experience. The Annals of Thoracic Surgery, 90, 869-873. [Google Scholar] [CrossRef] [PubMed]
[29] Pan, S., Xing, Q., Cao, Q., Wang, P., Duan, S., Wu, Q., et al. (2012) Perventricular Device Closure of Doubly Committed Subarterial Ventral Septal Defect through Left Anterior Minithoracotomy on Beating Hearts. The Annals of Thoracic Surgery, 94, 2070-2075. [Google Scholar] [CrossRef] [PubMed]
[30] Liu, L., Zhao, T.L., Yang, Y.F., Wang, X., Ying, N., Wu, Q., et al. (2013) Intraoperative Device Closure of Subaortic Ventricular Septal Defects. Journal of Cardiac Surgery, 28, 456-460. [Google Scholar] [CrossRef] [PubMed]
[31] Lin, K., Zhu, D., Tao, K., Gan, C., Tang, H., Feng, Y., et al. (2013) Hybrid Perventricular Device Closure of Doubly Committed Subarterial Ventricular Septal Defects: Mid‐Term Results. Catheterization and Cardiovascular Interventions, 82, E225-E232. [Google Scholar] [CrossRef] [PubMed]
[32] Gao, Q., Jin, J., Zhang, Z., Ma, L., Li, J. and Yu, J. (2021) A Study on Eccentric Occluder via Ultra Minimal Incision of Doubly Committed Subarterial Ventricular Septal Defects. Journal of Cardiac Surgery, 36, 2055-2060. [Google Scholar] [CrossRef] [PubMed]
[33] Gan, C., Peng, L., Liang, Z., Song, H., Yang, J., Ruan, W., et al. (2017) Percutaneous Perventricular Device Closure of Ventricular Septal Defect: From Incision to Pinhole. The Annals of Thoracic Surgery, 103, 172-177. [Google Scholar] [CrossRef] [PubMed]
[34] Zhou, S., Zhao, L., Fan, T., Li, B., Liang, W., Dong, H., et al. (2017) Perventricular Device Closure of Doubly Committed Sub-Arterial Ventricular Septal Defects via a Left Infra-Axillary Approach. Journal of Cardiac Surgery, 32, 382-386. [Google Scholar] [CrossRef] [PubMed]
[35] Hu, X., Peng, B., Zhang, Y., Ai, F. and Zheng, J. (2018) Short-term and Mid-Term Results of Minimally Invasive Occlusion of Ventricular Septal Defects via a Subaxillary Approach in a Single Center. Pediatric Cardiology, 40, 198-203. [Google Scholar] [CrossRef] [PubMed]
[36] 涂洪强, 陈苏江, 张盛, 等. 高位室间隔缺损患儿经胸微创封堵的治疗效果[J]. 实用临床医学, 2023, 24(1): 22-24, 62.
[37] 徐铁伟, 谢林, 赁可. 干下型室间隔缺损经胸封堵术后中期随访结果[J]. 中国胸心血管外科临床杂志, 2021, 28(11): 1334-1339.
[38] 马伦超, 陈智斌, 谢少波, 等. 体外循环修补与经胸封堵治疗双动脉瓣下型室间隔缺损的对比研究[J]. 中华胸心血管外科杂志, 2019, 35(4): 246-249.
[39] Miyaji, K., Murakami, A., Kobayashi, J., Suematsu, Y. and Takamoto, S. (2001) Transxiphoid Approach for Intracardiac Repair Using Video-Assisted Cardioscopy. The Annals of Thoracic Surgery, 71, 1716-1718. [Google Scholar] [CrossRef] [PubMed]
[40] 祝忠群, 苏肇伉, 周爱卿. 先天性心脏病的镶嵌治疗[J]. 中华胸心血管外科杂志, 2004, 20(5): 314-316.

为你推荐