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VSD介入性治疗是有争议的问题。1988年，Lock等用Rashkind双伞闭合器关闭VSD以来，此技术一直在研究中。1994年，Sideris用纽扣式补片装置关闭VSD，其直径可达25mm。适应证要考虑不损伤瓣膜及腱束的功能，并且关闭VSD有可能引起左束支传导阻滞。近年来，Amplatzar封堵器研制成功，对于肌部、膜周部VSD介入治疗取得成功，开始应用临床，取得较高的技术成功率，有报道为98％。
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【思考题】
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1．试述PBMV的适应证和禁忌证。
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2．PTCA的适应证和成功标准是什么？
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3．试述冠状动脉B型病变的特征。
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4．试述房室旁路消融的标测方法及成功判断标准。
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参考文献
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[1] 苗来生，戴汝平，崔炜，等．经皮球囊二尖瓣扩张术后再狭窄及远期疗效．中华心血管病杂志，1998，26(2)
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[2] 陈纪言，周颖玲，李光，等．79例经皮球囊二尖瓣成形术患者10年远期疗效评价．中华心血管病杂志，1999，27(2)
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[3] 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task force on practice guidelines. J Am Coll Cardiol, 2008, 52
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[4] Popma JJ, Berger P, Ohman EM, et al. Antithrombotic therapy during percutaneous coronary intervention: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest, 2004, 126
:576S-599S.
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[5] Sidney C Smith, Jr Ted E et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: A report of the American College of Cardiology/American Heart Association Task force on practice guidelines. J Am Coll Cardiol, 2006, 47
:1-121.
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[6] American College of Cardiology/American Heart Association Task force on practice guidelines, 2007 writing group, 2007 focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention. J Am Coll Cardiol, 2008, 51
:172-209.
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[7] Steinhubl SR, Topol EJ. Stenting for acute myocardial infarction. Lancet, 1997, 350
:532-533.
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[8] Callans DJ, Schwartzman D, Gottlieb CD, et al. Insights into the eletrophsiology of accessory pathway-mediated arrhythmias provided by the catheter ablation experience: Iearning while burning, part Ⅲ. J Cardiovasc Electrophysiol, 1996, 7
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[9] 陈君柱，郑良荣，陶谦民，等．射频消融治疗预激综合征和房室结双径路200例报告．中华心律失常学杂志，1997，1(1)
:26．
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[10] 郑良荣，胡于健，陈君柱，等．预激综合征体表心电图旁路逐步定位法．浙江医科大学学报，1998，27(2)
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[11] 陈君柱，朱建华，张芙荣，等．经导管Rashkind双伞闭合器关闭动脉导管未闭．中华心血管病杂志，1995，23(3)
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[12] Thanopoulos BO, Laskari CV, Tsaousis GS, et al. Closure of atrial septal defects with the amplatzer occlusion device: Primary results. J Am Coll Cardiol, 1998, 31(5)
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（朱建华 陈君柱）
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内科学新进展 第五节 细胞移植治疗充血性心力衰竭进展
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摘 要 充血性心力衰竭（CHF）发病率逐年升高，已成为威胁公众健康的一大问题。近年来大量基础和临床研究提示，干细胞移植是一种崭新的治疗方法，骨髓基质干细胞（MSC）具有良好的分化潜能，能分化为心肌样细胞、血管内皮细胞和平滑肌细胞，从而再生心肌和血管，延缓心肌重塑，改善心肌收缩功能和室壁顺应性，促进血管再生，建立有效冠脉侧支循环，提高心脏整体功能，既改善了血供又解决心肌细胞数量减少这一心力衰竭的根本原因；而且自体移植不受来源限制，取材方便、创伤小，也不存在免疫排斥和基因突变等安全性问题，因此作为充血性心力衰竭治疗的新途径有着广阔的前景。现就近年来国内外MSC自体移植在治疗CHF方面的研究进展作一综述。
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Abstract The incidence rate of congestive heart failure is annually increasing, which is threaten for the public health. In the recent years a large number of basic and clinical studies showed that stem cell transplantation was a new treatment. The bone marrow-induced mesenchymal stem cells（MSCs）have multi-potent to differentiate into cardiomyocytes andvascular endothelial cells. And smooth muscle cells, which contributes to myocardium regeneration, revascularization, and ventricular remodeling with the improvement of cardiac function and compliance. Withmore, MSCs transplantation promotes neoangiogensis, establishes coronary collaterals, improves global cardiac function and attenuates cardiomyocytes less, thus retard heart failure. Autologous MSCs transplantio transplantation is unlimited, available, easy taken, noninvasive, without no immune rejection, gene mutation or other safety problems. It is a new way to treat congestive heart failure with autologous MSC transplantation and with bright prospects. In this review, the development of autologous MSC transplantation in the treatment of congestive heart failure is in troduced as follows.
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