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目的探讨经导管介入治疗主动脉瓣下边缘<2 mm的室间隔缺损的可行性及疗效。方法回顾性分析2010年5月至2016年5月接受介入治疗的室间隔缺损患者156例临床资料。根据术前超声测量的主动脉瓣下边缘距离分为短边组(<2 mm,n=69)和长边组(≥2 mm,n=87)。对两组治疗效果及术后并发症进行比较,并对短边组介入治疗失败的危险因素等指标进行分析。结果短边组介入治疗成功率78.3%,长边组介入治疗成功率为96.6%,两组差异有统计学意义(P<0.01)。短边组轻微主动脉瓣反流5例,术后心律失常23例,残余分流6例,无机械性溶血发生。长边组轻微主动脉瓣反流1例,心律失常14例,残余分流6例,其中2例出现轻微溶血。短边组Logistic回归分析结果显示,术前合并主动脉瓣脱垂(OR=8.8,95%CI:1.4~54.9,P=0.02)及VSD缺损≥5 mm(OR=11.6,95%CI:2.37~57.11,P=0.003)为介入治疗失败独立危险因素。结论主动脉瓣下边缘<2 mm的VSD介入治疗成功率较低,术前合并主动脉瓣脱垂及缺损≥5 mm患者是介入治疗失败的危险因素,需严格掌握介入治疗适应证。
Objective To investigate the feasibility and efficacy of transcatheter interventional treatment of ventricular septal defect with <2 mm inferior border of aortic valve. Methods The clinical data of 156 patients with ventricular septal defect receiving interventional therapy from May 2010 to May 2016 were retrospectively analyzed. According to preoperative ultrasound measured aortic valve under the edge of the distance was divided into short side (<2 mm, n = 69) and long side (≥ 2 mm, n = 87). The curative effect and postoperative complication of the two groups were compared, and the risk factors and other indicators of the short-term intervention were analyzed. Results The success rate of intervention in short-side group was 78.3%, and that in long-side group was 96.6%. There was significant difference between the two groups (P <0.01). Short aortic valve regurgitation in 5 cases, 23 cases of arrhythmia, residual shunt in 6 cases, no mechanical hemolysis occurred. One case of minor aortic regurgitation in the long side group, 14 cases of arrhythmia, 6 cases of residual shunt, of which 2 cases had mild hemolysis. Logistic regression analysis showed that preoperative aortic valve prolapse (OR = 8.8,95% CI: 1.4-54.9, P = 0.02) and VSD defect≥5 mm (OR = 11.6,95% CI: 2.37 ~ 57.11, P = 0.003) were independent risk factors for failure of interventional therapy. Conclusions The success rate of interventional treatment of VSD less than 2 mm in the aortic valve is low. Preoperative combination of aortic valve prolapse and defect ≥5 mm is a risk factor for failure of interventional therapy.