超声引导下经胸或经皮封堵治疗室间隔缺损的进展
Progress in Transthoracic or Percutaneous Device Closure of Ventricular Septal Defect Guided by Transesophageal Echocardiography
DOI: 10.12677/acm.2024.1441168, PDF,   
作者: 高 植, 李红昕*：山东大学齐鲁医学院，山东 济南
关键词: 室间隔缺损；微创；介入治疗；Ventricular Septal Defect； Minimal Invasive； Interventional Treatment
摘要: 室间隔缺损(Ventricular septal defect, VSD)是一种常见的先天性心脏病，约占全部先天性心脏病的20%~30%。根据解剖学位置，VSD可分为膜周部、双动脉干下型和肌部。近年来，经食道超声心动图(Transesophageal echocardiography, TEE)引导下经皮或经胸封堵治疗VSD被广泛推广应用，因其创伤小、手术时间短、操作简便、成功率高、并发症少等优点，目前已成为国内微创治疗VSD的主要手段。除了TEE引导下经股动脉途径的经皮介入，TEE引导下经胸途径又根据VSD病理解剖特点，分为经右胸、左胸和胸骨下段小切口三种途径。如何根据VSD解剖特点，在TEE引导下选择不同的封堵路径和封堵器，达到更安全、可靠的治疗效果，同时减少手术并发症以及提高手术成功率，正是本文综述的目的。
Abstract: The ventricular septal defect (VSD) is a prevalent congenital heart disease, accounting for approximately 20%~30% of all cases of congenital heart disease. Based on anatomical location, VSD can be categorized into three types: perimembranous, subarterial, and muscular. In recent years, transesophageal echocardiography (TEE) guided percutaneous or transthoracic small incision closure therapy for VSD has been widely promoted and applied. Due to its advantages of small trauma, short surgical time, simple operation, high success rate, and few complications, it has become a widely used treatment for VSD in China. The purpose of this article is to review how to select different occlusion pathways and devices under TEE guidance based on the anatomical characteristics of VSD, in order to achieve safer and more reliable treatment outcomes, reduce surgical complications, and improve surgical success rates.
文章引用：高植, 李红昕. 超声引导下经胸或经皮封堵治疗室间隔缺损的进展[J]. 临床医学进展, 2024, 14(4): 1356-1365. https://doi.org/10.12677/acm.2024.1441168

参考文献

[1] Rudolph, A.M. (2009) Congenital Diseases of the Heart: Clinical-Physiological Considerations. Wiley-Blackwell, Hoboken. [Google Scholar] [CrossRef] 
[2] Soto, B., Becker, A.E., Moulaert, A.J., Lie, J.T. and Anderson, R.H. (1980) Classification of Ventricular Septal Defects. Heart, 43, 332-343. [Google Scholar] [CrossRef] [PubMed]
[3] 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] 
[4] Masura, J., Gavora, P., Formanek, A. and Hijazi, Z.M. (1997) Transcatheter Closure of Secundum Atrial Septal Defects Using the New Self-Centering Amplatzer Septal Occluder: Initial Human Experience. Catheterization and Cardiovascular Diagnosis, 42, 388-393. [Google Scholar] [CrossRef] 
[5] Yang, J., Yang, L., Wan, Y., et al. (2010) Transcatheter Device Closure of Perimembranous Ventricular Septal Defects: Mid-Term Outcomes. European Heart Journal, 31, 2238-2245. [Google Scholar] [CrossRef] [PubMed]
[6] Butera, G., Chessa, M. and Carminati, M. (2007) Percutaneous Closure of Ventricular Septal Defects. State of the Art. Journal of Cardiovascular Medicine, 8, 39-45. [Google Scholar] [CrossRef] 
[7] Amin, Z., Berry, J.M., Foker, J.E., Rocchini, A.P. and Bass, J.L. (1998) Intraoperative Closure of Muscular Ventricular Septal Defect in a Canine Model and Application of the Technique in a Baby. The Journal of Thoracic and Cardiovascular Surgery, 115, 1374-1376. [Google Scholar] [CrossRef] 
[8] Amin, Z., Danford, D.A., Lof, J., Duncan, K.F. and Froemming, S. (2004) Intraoperative Device Closure of Perimembranous Ventricular Septal Defects without Cardiopulmonary Bypass: Preliminary Results with the Perventricular Technique. The Journal of Thoracic and Cardiovascular Surgery, 127, 234-241. [Google Scholar] [CrossRef] [PubMed]
[9] Li, F., Chen, M., Qiu, Z., Lu, J. and Wu, W. (2008) A New Minimally Invasive Technique to Occlude Ventricular Septal Defect Using an Occluder Device. The Annals of Thoracic Surgery, 85, 1067-1071. [Google Scholar] [CrossRef] [PubMed]
[10] Gan, C., An, Q., Lin, K., et al. (2008) Perventricular Device Closure of Ventricular Septal Defects: Six Months Results in 30 Young Children. The Annals of Thoracic Surgery, 86, 142-146. [Google Scholar] [CrossRef] [PubMed]
[11] Zeng, X.J., Sun, S.Q., Chen, X.F., et al. (2008) Device Closure of Perimembranous Ventricular Septal Defects with a Minimally Invasive Technique in 12 Patients. The Annals of Thoracic Surgery, 85, 192-194. [Google Scholar] [CrossRef] [PubMed]
[12] Xing, Q., Pan, S., An, Q., et al. (2010) Minimally Invasive Perventricular Device Closure of Perimembranous Ventricular Septal Defect without Cardiopulmonary Bypass: Multicenter Experience and Mid-Term Follow-Up. The Journal of Thoracic and Cardiovascular Surgery, 139, 1409-1415. [Google Scholar] [CrossRef] [PubMed]
[13] 邢泉生, 庄忠云, 泮思林, 等. 应用新型输送系统经胸微创封堵膜周部室间隔缺损[J]. 中华实验外科杂志, 2007, 24(9): 1135-1136, 1154.
[14] 李红昕, 张慧, 郭文彬, 等. 探条辅助微创室间隔缺损封堵术[J]. 中华胸心血管外科杂志, 2011, 27(5): 271-272.
[15] Liang, F., Hongxin, L., Zhang, H.Z., Wenbin, G., Zou, C.W. and Farhaj, Z. (2017) Perventricular Double-Device Closure of Wide-Spaced Multi-Hole Perimembranous Ventricular Septal Defect. Journal of Cardiothoracic Surgery, 12, Article No. 24. [Google Scholar] [CrossRef] [PubMed]
[16] Changwe, G.J., Hongxin, L., Zhang, H.Z., et al. (2021) Percardiac Closure of Large Apical Ventricular Septal Defects in Infants: Novel Modifications and Mid-Term Results. Journal of Cardiac Surgery, 36, 928-938. [Google Scholar] [CrossRef] [PubMed]
[17] 吕蓓, 陈瑞, 任悦义, 等. 超声引导下经胸微创封堵治疗先心病的远期随访结果分析[J]. 临床小儿外科杂志, 2022, 21(2): 162-169.
[18] 李红昕, 梁飞, 郭文彬, 等. 经右胸——右心房途径微创室间隔缺损封堵术[J]. 中华胸心血管外科杂志, 2012, 28(12): 712-715.
[19] 李红昕, 郭文彬, 张海洲, 等. 经右胸或左胸途径微创封堵膜周部室间隔缺损[J]. 中华小儿外科杂志, 2015, 36(8): 577-581.
[20] Hongxin, L., Zhang, N., Wenbin, G., et al. (2014) Peratrial Device Closure of Perimembranous Ventricular Septal Defects through a Right Parasternal Approach. The Annals of Thoracic Surgery, 98, 668-674. [Google Scholar] [CrossRef] [PubMed]
[21] Song, S., Fan, T., Li, B., et al. (2017) Minimally Invasive Peratrial Device Closure of Perimembranous Ventricular Septal Defect through a Right Infraaxillary Route: Clinical Experience and Preliminary Results. The Annals of Thoracic Surgery, 103, 199-204. [Google Scholar] [CrossRef] [PubMed]
[22] Hongxin, L., Wenbin, G., Liang, F., Zhang, H.Z., Zhu, M. and Zhang, W.L. (2015) Perventricular Device Closure of a Doubly Committed Juxtaarterial Ventricular Septal Defect through a Left Parasternal Approach: Midterm Follow-Up Results. Journal of Cardiothoracic Surgery, 10, Article No. 175. [Google Scholar] [CrossRef] [PubMed]
[23] 张玉展, 李红昕, 邹承伟, 郭文彬, 袁贵道, 梁飞. 经胸骨旁途径嵴内型嵴上型室间隔缺损微创封堵术[J]. 中华胸心血管外科杂志, 2013, 29(1): 8-11.
[24] 潘湘斌, 逄坤静, 欧阳文斌, 等. 单纯超声心动图引导下经皮室间隔缺损封堵术的应用研究[J]. 中国循环杂志, 2015(8): 774-776.
[25] Zhu, D., Gan, C., Li, X., et al. (2013) Perventricular Device Closure of Perimembranous Ventricular Septal Defect in Pediatric Patients: Technical and Morphological Considerations. The Thoracic and Cardiovascular Surgeon, 61, 300-306. [Google Scholar] [CrossRef] [PubMed]
[26] 李延军, 刘罡, 杜德禄, 李俊杰. 超声引导下经皮室间隔缺损封堵术与经胸小切口室间隔缺损封堵术疗效比较[J]. 新乡医学院学报, 2019, 36(3): 262-264.
[27] 陈苏江, 严济泳, 刘庆华, 俞波, 赵伟. 经食道超声心动图在开胸微创封堵室间隔缺损术中的应用[J]. 江西医药, 2018, 53(12): 1476-1477, 1498.
[28] 贾龑婷. 食道超声引导下经胸小切口封堵术治疗复合型先天性心脏病的临床研究[D]: [博士学位论文]. 济南: 山东大学, 2017.
[29] .Earing, M.G., Cabalka, A.K., Seward, J.B., Bruce, C.J., Reeder, G.S. and Hagler, D.J. (2004) Intracardiac Echocardiographic Guidance during Transcatheter Device Closure of Atrial Septal Defect and Patent Foramen Ovale. Mayo Clinic Proceedings, 79, 24-34. [Google Scholar] [CrossRef] [PubMed]
[30] 潘湘斌, 李泽夫. 中国原创心血管器械研发的新领域——室间隔缺损可降解封堵器获批上市的启示[J]. 中国循环杂志, 2022, 37(8): 766-768.
[31] 潘湘斌, 曹华, 李红昕, 赵天力. 单纯超声心动图引导经皮介入技术中国专家共识[J]. 中国循环杂志, 2018, 33(10): 943-952.

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