Zayid Hijazi教授 美国芝加哥拉什大学医学中心

　　<International Circulation> : Thank you very much Dr. Hijazi for accepting this interview. My first question is about congenital heart defects. As a world-renowned interventional cardiologist， you specialize in the treatment of congenital and structural heart disease in both children and adults and have pioneered the nonsurgical repair of these defects. Could you please talk about how to deal with patient selection， procedural monitoring and follow-up of device closure for ventricular septal defects?

　　《国际循环》：非常感谢您接受我们的采访。我的第一个问题是关于先天性心脏病。作为世界知名的介入心脏病学专家，您的专业是儿童和成人先天性和结构性心脏病的治疗，并开拓了对这些疾病的非手术治疗。您能介绍关于如何为室间隔缺损封堵术选择患者、术中检测以及随访？

　　Prof. Hijazi: Thank you Jeremy. We are the medical college of San Francisco. So the field of congenital and structural heart disease has blossomed over the last five to ten years. A large number of children are born with congenital heart disease but an even larger number of adults acquire valvular heart disease and that’s what causes structural heart disease. Just for example in the United States there is approximately 1.2 million adults with congenital heart disease and a few million with atrial fibrillation， macular degeneration… Now this is the field to get into and this is the buzz word， “congenital and structural heart disease”. Now to come back to the second part of the question about how to deal with patients selection for ventricular septal defects. The ventricular septal defect also known as VSD， is the most common form of congenital heart disease. So thirteen percent of patients with congenital heart disease have VSD. Let me give you an example. In China alone there is at least one to two million patients with VSD. So it’s very common. So how do we decide which patients to select for closure of ventricular septal defects versus you should send them to the surgeon for open heart surgery. There are two types of ventricular septal defects. The most common type is called a perimembranous septal defect， which is a hole in the upper section of the ventricular septum. This is close to the aortic valve， close to the electrical system of the heart. The second type is the muscular type. This is far away from the aortic valve， far away from the electrical system. The first type， the perimembranous， is very close to the electrical system of the heart so if we have started evaluating a device to close such defects. Actually the success rate was very high. The problem we encountered because the electrical system is so close is a few percentage of patients， up to about four percent， developed what we call “heart block” and unfortunately， at least to me， this is not acceptable. So right now if I have a patient with perimembranous VSD my selection for them would be older children， three or four years of age， because the chance of heart block is less. Second of all， the hole needs to be a little far from the aortic valve. If they meet this criteria I can safely say to the family that I will close this hole without the fear of developing heart block or a leak in the aortic valve. For the second type， the muscular VSD， the treatment of choice is catherization because it’s better than a surgeon and it’s far from the heart’s electrical valve. So that’s how we select the patients. The results are excellent for both， muscular and perimembranous and I usually follow these patients within about one month from the procedure to make sure there’s no new complications. If the follow up within one month is good then I see them again after one year and then every one to two years for their lifetime to make sure there’s no new complication that could happen with these devices to cause complications as time goes by.

　　Hijazi教授：我们旧金山医学院在先天性和结构性心脏病领域方面已经发展了5到10年。很多儿童出生时有先天性心脏病，更多的成年人患有心脏瓣膜病，这两者造成了结构性心脏病。例如，在美国大约有120万成年人有先天性心脏病，有数百万人有房颤和瓣膜退变。这就是本领域的情况，术语叫“先天性和结构性心脏病”。回到问题第二个部分，关于如何选择室间隔缺损的患者。室间隔缺损，简称VSD，是最常见的先天性心脏病。大约13%的先天性心脏病患者有VSD。仅在中国就有至少一百万到两百万VSD患者。因此VSD非常常见。那么，我们如何选择哪些患者接受封堵术，哪些患者应当接受外科开胸心脏手术。有两种类型室间隔缺损。最常见的类型叫膜周部室间隔缺损，即在室间隔上部有一个小孔，离主动脉瓣和心脏传导系统距离近。第二种是肌部缺损，离主动脉瓣和心脏传导系统距离远。第一种离心脏传导系统很近，我们对器械封堵进行评估，成功率非常高，但我们遇到的问题是大约有百分之几的患者，最高可达4%，会发生“心脏传导阻滞”，至少对于我来说，这个结果是不可接受的。因此目前对于膜周部VSD患者，我会选择年龄较大，3~4岁儿童进行封堵术，因为心脏传导阻滞几率较小。第二，室间隔孔需要和主动脉瓣有一些距离。如果患者满足以上标准，我可以和家属说，我会进行封堵术，而不担心发生心脏传导阻滞或主动脉瓣反流。对于第二种类型，肌部缺损，治疗选择经导管封堵术。因为这种缺损离心脏传导系统和瓣膜远，因此效果优于外科手术。这是我们选择患者的方法。两种病变的封堵效果都很好，我通常随访患者大约1个月，以确定没有新的并发症。如果1个月内随访结果好，我会1年后再次随访患者，然后终生每1~2年随访1次，以确定随时间推移，封堵装置没有新的并发症。

　　<International Circulation> : What’s the different in the treatment between the perimembranous and muscular?

　　《国际循环》：膜周部缺损和肌部缺损的治疗有何区别？

　　Prof. Hijazi: The perimembranous is very close to the aortic valve and the muscular which is in the muscular part between the left ventricle and the right ventricle. Muscular VSD is safer to close with a device because it is farther away and doesn’t interfere with the electrical system.

　　Hijazi教授：膜周部缺损离主动脉瓣很近，而肌部缺损在左心室和右心室之间的肌肉部分。肌部VSD封堵治疗更加安全，因为离心脏传导系统更远，不会对其产生影响。