Abstract:

Objective　To investigate the efficacy and safety of transesophageal echocardiography (TEE) guided right axillary small incision ventricular septal defect closure in the treatment of perimembranous ventricular septal defect (PmVSD). Methods　A total of 98 PmVSD children who underwent surgical treatment in Henan Children's Hospital from May 2020 to May 2021 were selected and were divided into two groups according to the operation type: a closure group (50 cases) and a repair group (48 cases). In the closure group, there were 28 boys and 22 girls, aged (3.25±0.40) years. In the repair group, there were 26 boys and 22 girls, aged (3.68±0.31) years. The closure group underwent TEE guided right axillary small incision ventricular septal defect closure, while the repair group underwent right axillary direct incision surgical repair under cardiopulmonary bypass. Both groups were followed up for 2 years. The operation conditions and the differences of myocardial injury and cardiac function were compared between the two groups. t test, χ² test, and Fisher exact probability method were used. Results　The success rates of operation in the closure group and the repair group were 98.00% (49/50) and 100.00% (48/48), respectively, and there was no statistically significant difference between the two groups (P>0.05). The operation time, ICU stay, and hospital stay in the closure group were shorter than those in the repair group [(74.25±11.58) min vs. (133.69±28.78) min, (4.60±1.00) h vs. (6.82±1.23) h, (4.05±0.69) d vs. (7.03±1.25) d] (all P<0.05), and the drainage volume within 24 h after operation was lower than that of the repair group [0 vs. (67.50±15.69) ml] (P<0.05). The levels of cardiac troponin I (cTnI) and creatine kinase isoenzyme (CK-MB) in the closure group were lower than those in the repair group 24 h after operation (both P<0.05). There were no statistically significant differences in the cardiac function indexes between the two groups before and 2 years after operation (all P>0.05). There were no statistically significant differences in the incidence of residual shunt or new tricuspid regurgitation between the two groups within 2 years after operation (all P>0.05). However, the incidences of new abnormal electrocardiogram in the closure group 3, 6, 12, and 24 months after operation were lower than those in the repair group [10.00% (5/50) vs. 27.08% (13/48), 6.00 (3/50) vs. 20.83% (10/48), 4.00% (2/50) vs. 16.67% (8/48), 2.00% (1/50) vs. 12.50% (6/48)] (all P<0.05). Conclusion　TEE-guided right axillary small incision ventricular septal defect closure and surgical repair both have good long-term follow-up results for PmVSD, but TEE guided right axillary small incision ventricular septal defect closure has the advantages of faster postoperative recovery, less myocardial damage, and more minimally invasive incision.

Key words:

Perimembranous ventricular septal defect, Transesophageal echocardiography, Right axillary small incision ventricular septal defect closure, Curative effect, Cardiac function

摘要：

目的　探究经食管超声心动图（TEE）引导下右腋下小切口室间隔缺损封堵术治疗膜周部室间隔缺损（PmVSD）的疗效，并分析其安全性。方法　选取2020年5月至2021年5月在河南省儿童医院行手术治疗的PmVSD患儿98例，依据术式分为封堵组（50例）和修补组（48例）。封堵组男28例，女22例，年龄（3.25±0.40）岁；修补组男26例，女22例，年龄（3.68±0.31）岁。封堵组行TEE引导下右腋下小切口室间隔缺损封堵术治疗，修补组行体外循环下经右腋下直切口外科修补术，对两组患儿均进行2年的术后随访。统计两组患儿的手术情况，比较两组患儿心肌损伤、心功能的差异。行t检验、χ²检验、Fisher确切概率法。结果　封堵组和修补组的手术成功率分别为98.00%（49/50）和100.00%（48/48），两组比较差异无统计学意义（P>0.05）；但封堵组手术时间、住ICU时间以及住院时间均短于修补组［（74.25±11.58）min比（133.69±28.78）min，（4.60±1.00）h比（6.82±1.23）h，（4.05±0.69）d比（7.03±1.25）d］（均P<0.05），且其术后24 h引流量少于修补组［0比（67.50±15.69）ml］（P<0.05）。封堵组患儿术后24 h的心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）水平均较修补组低（均P<0.05）。两组患儿术前、术后2年的各心功能指标比较差异均无统计学意义（均P>0.05）。两组术后2年残余分流、三尖瓣新发返流发生情况比较差异均无统计学意义（均P>0.05），但封堵组术后3、6、12、24个月的新发异常心电图发生率均较修补组低［10.00%（5/50）比27.08%（13/48）、6.00（3/50）比20.83%（10/48）、4.00%（2/50）比16.67%（8/48）、2.00%（1/50）比12.50%（6/48）］（均P<0.05）。结论　TEE引导下右腋下小切口室间隔缺损封堵术与外科修补手术治疗PmVSD远期随访效果良好，但相较而言TEE引导下右腋下小切口室间隔缺损封堵术具有术后恢复更快、心肌损伤小以及切口更加微创的优势。

关键词:

膜周部室间隔缺损, 经食管超声心动图, 右腋下小切口室间隔缺损封堵术, 疗效, 心功能