Objective: To investigate the effect of modified percutaneous closure in the treatment of ventricular septal rupture. Methods: This study is a retrospective cohort study. Forty-four patients with ventricular septal rupture who underwent percutaneous closure at the Fuwai Central China Cardiovascular Hospital from December 2017 to October 2023 were included. According to the closure method, patients were divided into the modified group (11 cases) and the traditional group (33 cases). Surgical success was defined as successful placement of the occluder. The operation time, X-ray intake, sheath bending rate, incidence of ventricular fibrillation and pericardial tamponade, and postoperative residual shunt were compared between the two groups. Results: The age of the patients was (75.0±5.7) years, with 20 (45%) males. There were 3 cases of operation failure in the traditional group, while all patients in the modified group were successfully occluded. The procedure time in the modified group was shorter than that in the traditional group (40 (35, 45) min vs. 60 (50, 65)min, P<0.001); X-ray dose intake was lower ((442.43±73.26)mGy vs. (784.45±247.78)mGy, P<0.001). There was no occurrence of sheath bending in the modified group, while the incidence of sheath bending in the traditional surgery group was 46% (15/33), and the difference was statistically significant (P=0.017). Intraoperative ventricular fibrillation and pericardial tamponade occurred in 7 cases (21%) and 2 cases (6%) in the traditional group respectively, while none occurred in the modified group, but the differences between the groups were not statistically significant (both P>0.05). There was no significant difference in residual shunt between the two groups (3.6 (2.5, 4.3) mm vs. 4.0 (3.5, 4.5) mm,P=0.506). Conclusion: The procedure of modified ventricular septal rupture closure is more simplified, with a lower incidence ofventricular fibrillation and pericardial tamponade.
目的： 探讨改良经皮封堵术在急性心肌梗死后室间隔穿孔中的应用效果。 方法： 本研究为回顾性队列研究。入选2017年12月至2023年10月于阜外华中心血管病医院行经皮介入封堵的室间隔穿孔患者44例，根据封堵方法将患者分为改良手术组（11例）和传统手术组（33例）。手术成功定义为封堵伞放置成功。比较两组的手术时间，X线吸收剂量，输送鞘打折率，心室颤动、心包填塞发生率及术后残余分流。 结果： 患者的年龄为（75.0±5.7）岁，其中男性20（45%）例。传统手术组手术失败3例，改良手术组患者均手术成功。与传统手术组比较，改良手术组的手术时间更短［40（35，45）min比60（50，65）min，P<0.001］；X线吸收剂量更低［（442.43±73.26）mGy比（784.45±247.78）mGy，P<0.001］。术中改良手术组无输送鞘打折出现，而传统手术组输送鞘打折发生率为46%（15/33），差异有统计学意义（P=0.017）。传统手术组术中发生心室颤动7例（21%）和心包填塞2例（6%），而改良手术组未发生心室颤动和心包填塞，但组间差异无统计学意义（P均>0.05）。术后残余分流传统手术组和改良手术组差异无统计学意义［3.6（2.5，4.3）mm比4.0（3.5，4.5）mm，P=0.506］。 结论： 改良经皮室间隔穿孔封堵术操作更加简化，心室颤动及心包填塞发生率更低。.