摘要
目的：心律失常是封堵器置入治疗膜周部室间隔缺损严重并发症之一，目前尚无明确有效的预防方法。分析封堵器置入膜部瘤体内能否预防严重心律失常的发生。
方法：选择2002-01/2007-06河北医科大学第一医院共完成治疗室间隔缺损患儿1 810例，其中采用封堵器置入治疗644例，以封堵器左盘面是否跨越左心室基底部为界分为置入膜部瘤体与置入左心室基底部两种。外科手术治疗1 166例。术后严格综合监护1周，出院前复查心电图和超声心动图，出院后1，3，6，12，24个月作定期随访超声心动图、心电图。
结果：①封堵器置入组的三度房室传导阻滞和完全性左束支传导阻滞的发生率高于外科手术组(P < 0.05)，而二度Ⅱ型房室传导阻滞的发生率低于外科手术组(P < 0.05)。②对于伴膜部瘤形成者，封堵器置入组的三度房室传导阻滞和完全性左束支传导阻滞的发生率高于外科手术组(P < 0.05)；而如果将封堵器置入膜部瘤体内，发生三度房室传导阻滞、二度Ⅱ型房室传导阻滞及完全性左束支传导阻滞均明显低于置入基底部者(P < 0.05)，也明显低于不伴膜部瘤形成而置入基底部组及外科手术组（包括伴膜部瘤形成和不伴膜部瘤形成）(P < 0.05)。③对于外科手术组，伴膜部瘤形成和不伴膜部瘤形成者术后严重心律失常的发生率无统计学意义(P > 0.05)。④材料与组织的生物相容性：封堵器置入体内后血小板黏附较少，凝血功能检查、免疫系统反应（免疫球蛋白、补体）、 材料表面再内皮化反应均正常，未发生炎症等宿主反应。无封堵器脱落等材料反应发生。
结论：①封堵器置入膜部瘤体可有效降低膜部瘤型室间隔缺损治疗后严重心律失常的发生。②封堵左室基底部时应特别注意避免封堵器过大变形。
关键词：封堵器；室间隔缺损；介入治疗；心律失常；医学植入体；生物相容性

解启莲，王军，闫宝勇，赵增仁，高磊，王震，张密林，周谨，樊文峰，刘坤申.封堵器置入部位与室间隔缺损治疗后的心律失常[J].中国组织工程研究与临床康复，2008，12(9):1618-1620
[www.zglckf.com/zglckf/ejournal/upfiles/08-9/9k-1618(ps).pdf]

Occluder implanting location and arrhythmia after transcatheter occlusion for ventricular septal defect

Abstract
AIM: Arrhythmia is one of the serious complications after transcatheter occlusion for ventricular septal defect (VSD). At present, there is still no effective preventive treatment for it. In this study, we investigated whether occluder implanting into ventricular septal aneurysms can prevent occurrence of severe arrhythmia after transcatheter closure of aneurysm-like VSD.
METHODS: From January 2002 to June 2007, 1 810 VSD patients were treated in the First Hospital of Hebei Medical University. Of them, six hundred and forty four patients were treated by occluder implantation. According to whether the left plate of occluder crossing the left ventricular base (LVB) or not, they were subdivided into VSA-body-implantation group and LVB-implantation group. Surgical treatment was performed in 1 166 patients. Rigorous integrated medical monitoring lasted for one week after surgery. Electrocardiogram (ECG) and echocardiography (TTE) were performed before and 1, 3, 6, 12 and 24 months after discharging.
RESULTS: ①In occluder-implantation group, the incidence rates of third degree atrioventricular (A-V) block and complete left bundle branch block were higher than in surgery group (P < 0.05), but the incidence of second degree A-V block was lower than in surgery group (P < 0.05). ②For aneurysm-like VSD, the incidence rates of third degree A-V block and complete left bundle branch block were higher in occluder-implantation group than in surgery group (P < 0.05); If the occluder was placed into VSA, the incidence rates of third and second degree A-V block and complete left bundle branch block were significantly lower than in LVB-implantation group (P < 0.05) and LVB-implantation-without-VSA group and surgery group (whether with VSA formation or not) (P < 0.05). ③For surgery group, no statistically significant difference in arrhythmia incidence was observed between VSA formation group and non-VSA formation group (P > 0.05). ④After occluder implantation, platelet adhesion was reduced, and coagulation function, immune system reaction (immunoglobulin, complement), reendothelialization on material surface were normal. No host response such as inflammation was found. No occluder dislocation or other material response was found either.
CONCLUSION: ①Occluder implantation into VSA body can effectively reduce the incidence of serious arrhythmia after transcatheter closure of aneurysm-like VSD. ②It is necessary to pay special attention to avoid the oversizing and deformation of occluder when closing LVB of VSD.

Xie QL, Wang J, Yan BY, Zhao ZR, Gao L, Wang Z, Zhang ML, Zhou J, Fan WF, Liu KS.Occluder implanting location and arrhythmia after transcatheter occlusion for ventricular septal defect. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(9):1618-1620(China) [www.zglckf.com/zglckf/ejournal/upfiles/08-9/9k-1618(ps).pdf]