年幼兒童經心導管關閉膜邊型心室中膈缺損後長期後遺症的風險因素

Abstract

背景： 罹患膜邊型心室中膈缺損（pmVSD）的病人，在接受經心導管關閉術而引起的併發症，如殘餘分流和主動脈逆流（AR），近年已陸續有許多研究觀察到。然而，目前尚不清楚與之相關的風險因素，特別是在兒童族群。本研究目的在於尋找2至12歲的年幼兒童之pmVSD經心導管關閉後殘餘分流和AR的相關風險因素。 方法和結果： 我們分析了在台大兒童醫院小兒心臟科，於2011年至2018年間接受經心導管關閉術的63名pmVSD兒童，其肺循環至全身循環血流比率低於2.0的醫療記錄，並進行了至少3年的追蹤。所有接受經心導管關閉術治療的兒童的成功率為98.4％，並無主要嚴重的併發症產生，例如緊急外科手術、永久性高度房室傳導阻滯或死亡。在殘餘分流的部分，心室中膈缺損若大於4.5mm則具有顯著較高的持續性殘餘分流風險（勝算比：6.85，p = 0.03）。使用比缺損直徑大1.5mm的關閉器尺寸顯示出減少殘餘分流的趨勢（勝算比：0.23，p = 0.06）。而年齡小於4歲（勝算比：27.38，95％CI：2.33–321.68）和出口型pmVSD（勝算比：11.94，95％CI：1.10–129.81）是關閉pmVSD後AR惡化的獨立風險因素。 結論： 對於超過4.5mm的pmVSD，需要特別注意追蹤經心導管關閉後的持續性殘餘分流。在考慮pmVSD關閉的好處時，仔細評估AR風險，特別是對於4歲以下兒童以及pmVSD分類，是至關重要的。

Background Complications arising from transcatheter closure of perimembranous ventricular septal defects (pmVSD) in children, such as residual shunts and aortic regurgitations (AR), have been observed. However, understanding the associated risk factors remains unclear. This study aims to identify risk factors linked with residual shunts and AR following transcatheter closure of pmVSD in children aged 2–12 years. Methods and Results Medical records of 63 children with pmVSD and a pulmonary-to-systemic blood flow ratio below 2.0 who underwent transcatheter closure between 2011 and 2018 in National Taiwan University Children Hospital were analyzed with a minimum 3-year follow-up. The success rate of transcatheter closure was 98.4%, with no emergent surgery, permanent high-degree atrioventricular block, or mortality. Defects exceeding 4.5 mm in diameter had significantly higher odds of persistent residual shunt (OR: 6.85, p = 0.03). The use of an oversize device (>1.5 mm) showed a trend toward reducing residual shunts (OR: 0.23, p = 0.06). Age under 4 years (OR: 27.38, 95% CI: 2.33–321.68) and perimembranous outlet type VSD (OR: 11.94, 95% CI: 1.10–129.81) were independent risk factors for AR progression post-closure. Conclusion Careful attention is crucial for pmVSDs larger than 4.5 mm to prevent persistent residual shunts in transcatheter closure. Assessing AR risk, particularly in children under 4 years old, is essential while considering the benefits of pmVSD closure.