目的对比偏心型和对称型封堵器在治疗膜周部室间隔缺损的安全性和有效性。方法通过计算机互联网检索数据库包括:生物医学与药理学文摘数据库,美国国家医学图书馆,Cochrane图书馆,中国期刊全文数据库及万方数据库。检索范围为建库到2017...目的对比偏心型和对称型封堵器在治疗膜周部室间隔缺损的安全性和有效性。方法通过计算机互联网检索数据库包括:生物医学与药理学文摘数据库,美国国家医学图书馆,Cochrane图书馆,中国期刊全文数据库及万方数据库。检索范围为建库到2017年2月1日。采用Rev Man 5.3软件数据处理,Meta分析偏心型和对称型封堵器在治疗膜周部室间隔缺损的治疗成功率、手术时间、完全闭合率(即刻)、Ⅲ度房室传导阻滞、右束支传导阻滞率和左束支传导阻滞率。结果 6篇文献纳入分析,均为单中心非随机对照研究。Meta分析结果显示对称型封堵器安放成功率(97.08%比96.38%,P=0.71)和即刻完全闭合率(97.51%比93.45%,P=0.30)均优于偏心型封堵器,Ⅲ度房室传导阻滞率(0.90%比1.39%,P=0.41)、左束支传导阻滞发生率(1.71%比3.05%,P=0.32)、右束支传导阻滞发生率(3.42%比4.95%,P=0.62)和手术所耗时间[MD=4.85,95%CI:-0.44~10.13,P=0.07]均低于偏心型封堵器。但是这些结论均没有统计学意义(P>0.05)。结论虽然本文分析出偏心型封堵器较对称型封堵器有太多弊端,但是这些差异都不具有统计学意义,所以不能否定该封堵器在临床上使用具有保护主动脉瓣膜的优势。临床上应该根据患者具体病情个体化治疗,选择恰当的封堵器,这样才能减少并发症的发生,让患者获得更佳的治疗效果。展开更多
A 54-year-old female patient with congenital heart disease had a persistent complete left bundle branch block three months after closure by an Amplatzer ventricular septal defect occluder. Nine months later, the patie...A 54-year-old female patient with congenital heart disease had a persistent complete left bundle branch block three months after closure by an Amplatzer ventricular septal defect occluder. Nine months later, the patient suffered from chest distress, palpitation, and sweating at daily activities, and her 6-min walk distance decreased significantly （155 m）. Her echocardiography showed increased left ventricular end-diastolic diameter with left ventricular ejection fraction of 37%. Her symptoms reduced significantly one week after received cardiac resynchronization therapy. She had no symptoms at daily activities, and her echo showed left ventricular ejection fraction of 46%and 53%. Moreover, left ventricular end-diastolic diameter decreased 6 and 10 months after cardiac resynchronization therapy, and 6-min walk dis-tance remarkably increased. This case demonstrated that persistent complete left bundle branch block for nine months after transcatheter closure with ventricular septal defect Amplatzer occluder could lead to left ventricular enlargement and a significant decrease in left ventricular systolic function. Cardiac resynchronization therapy decreased left ventricular end-diastolic diameter and increased left ventricular ejection fraction, thereby improving the patient’s heart functions.展开更多
文摘目的对比偏心型和对称型封堵器在治疗膜周部室间隔缺损的安全性和有效性。方法通过计算机互联网检索数据库包括:生物医学与药理学文摘数据库,美国国家医学图书馆,Cochrane图书馆,中国期刊全文数据库及万方数据库。检索范围为建库到2017年2月1日。采用Rev Man 5.3软件数据处理,Meta分析偏心型和对称型封堵器在治疗膜周部室间隔缺损的治疗成功率、手术时间、完全闭合率(即刻)、Ⅲ度房室传导阻滞、右束支传导阻滞率和左束支传导阻滞率。结果 6篇文献纳入分析,均为单中心非随机对照研究。Meta分析结果显示对称型封堵器安放成功率(97.08%比96.38%,P=0.71)和即刻完全闭合率(97.51%比93.45%,P=0.30)均优于偏心型封堵器,Ⅲ度房室传导阻滞率(0.90%比1.39%,P=0.41)、左束支传导阻滞发生率(1.71%比3.05%,P=0.32)、右束支传导阻滞发生率(3.42%比4.95%,P=0.62)和手术所耗时间[MD=4.85,95%CI:-0.44~10.13,P=0.07]均低于偏心型封堵器。但是这些结论均没有统计学意义(P>0.05)。结论虽然本文分析出偏心型封堵器较对称型封堵器有太多弊端,但是这些差异都不具有统计学意义,所以不能否定该封堵器在临床上使用具有保护主动脉瓣膜的优势。临床上应该根据患者具体病情个体化治疗,选择恰当的封堵器,这样才能减少并发症的发生,让患者获得更佳的治疗效果。
文摘A 54-year-old female patient with congenital heart disease had a persistent complete left bundle branch block three months after closure by an Amplatzer ventricular septal defect occluder. Nine months later, the patient suffered from chest distress, palpitation, and sweating at daily activities, and her 6-min walk distance decreased significantly （155 m）. Her echocardiography showed increased left ventricular end-diastolic diameter with left ventricular ejection fraction of 37%. Her symptoms reduced significantly one week after received cardiac resynchronization therapy. She had no symptoms at daily activities, and her echo showed left ventricular ejection fraction of 46%and 53%. Moreover, left ventricular end-diastolic diameter decreased 6 and 10 months after cardiac resynchronization therapy, and 6-min walk dis-tance remarkably increased. This case demonstrated that persistent complete left bundle branch block for nine months after transcatheter closure with ventricular septal defect Amplatzer occluder could lead to left ventricular enlargement and a significant decrease in left ventricular systolic function. Cardiac resynchronization therapy decreased left ventricular end-diastolic diameter and increased left ventricular ejection fraction, thereby improving the patient’s heart functions.
