Analysis on reasons for the failure in perventricular mini-incision closure of ventricular septal defect
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摘要: 目的：探讨经食管超声心动图（TEE）监测微创外科室间隔缺损（VSD）封堵术失败原因，以提高术前筛选水平和封堵成功率。方法：回顾性分析11例TEE监测经胸微创外科VSD封堵术失败的患者，根据粗筛时经胸超声心动图、术前和术中TEE监测所见，总结归纳封堵失败的原因。结果：低估VSD缺口大小、膜部瘤形成伴右室面多个破口致封堵器放置后残余分流、缺口形态怪异、术中并发症、放置封堵器后重度三尖瓣反流及中重度主动脉瓣反流是封堵失败的常见原因。结论：超声心动图应严格掌握微创外科VSD封堵术的适应证，并合理选择封堵器类型及大小，以提高封堵成功率。Abstract: Objective: To explore the reasons for the failure of transesophageal echocardiography(TEE) monitoring in perventricular mini-incision transthoracic closure of ventricular septal defect(VSD), in order to improve the screening level before operation and improve the rate of success. Method: Eleven cases who failed in perventricular mini-incision closure of VSD were retrospectively analyzed.The reasons for the failure of closure in VSD according to the transthoracic echocardiography, TEE and surgical finding were summed up. Result: Underestimation of the size of VSD and membranous aneurysm with multiple outlets of VSD on the right ventricle side resulted in residual shunt after placed closure device, weirdly-shaped VSD gaps, intraoperative complications, serious tricuspid regurgitation and moderate to severe aortic valve regurgitation after placed closure device were the common reasons for the failure of closure in VSD. Conclusion: Echocardiography should screen the indications strictly, and select the type and size of closure device reasonably, in order to improve the rate of success.
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Key words:
- perventricular closure /
- ventricular septal defect /
- failure of closure
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