小儿复合先天性心脏病的介入治疗  

Interventional therapy for the multiple congenital heart diseases in children

作　　者：高虹[1] 叶钜亨[1] 张智伟[2] 董少红[1] 罗林杰[1] 

机构地区：[1]暨南大学第二临床医学院心内科,广东深圳518020 [2]广东省人民医院心血管病研究所

出　　处：《临床心血管病杂志》2010年第6期446-449,共4页Journal of Clinical Cardiology

摘　　要：目的:探讨小儿复合先天性心脏病(先心病)经导管介入治疗的策略及评价其疗效和安全性。方法:55例复合先心病患儿,先心病类型包括:肺动脉瓣狭窄(PS)合并房间隔缺损(ASD);PS合并动脉导管未闭(PDA);PS合并室间隔缺损(VSD);ASD合并PDA;ASD合并VSD;PDA合并VSD;室间隔完整的肺动脉闭锁(PA/IVS)合并PDA和卵圆孔未闭(PFO);主动脉瓣狭窄合并PDA;PDA合并肺隔离症。分别行射频打孔,经皮球囊肺动脉瓣成形术(PBPV),经皮球囊主动脉瓣成形术(PBAV),VSD封堵术,PDA封堵术,ASD封堵术,侧支血管堵塞术。结果:55例患儿经导管介入治疗均获得成功,术中未发生严重并发症,55例行介入堵闭均未见残余分流,堵闭器位置良好;30例行PBPV术,跨肺动脉瓣压差由术前平均(63.4±36.3)mmHg(1mmHg=0.133kPa),下降到术后平均(18.1±13.0)mmHg(P<0.01);1例行PBAV术,跨主动脉瓣压差由术前90mmHg下降到术后50mmHg;3例PA/IVS行射频打孔和PBPV术,术后肺动脉瓣开放满意,血氧饱和度维持良好。结论:复合先心病经导管介入治疗疗效确切、安全有效,但手术操作难度大,技术要求高,应该在较大心血管医院开展,并由有较丰富导管操作经验的医师施行。Objective：To evaluate the methods,efficacy and safety of interventional therapy for children with congenital heart diseases.Method：There were 55 children with the combined congenital heart diseases performed by transcatheter closures in this study,including 17 patients with pulmonary stenosis （PS） and atrial septal defect （ASD）;12 patients with PS and patent ductus arteriosus （PDA）;1 patient with PS and ventricular septal defect （VSD）;11 patients with ASD and PDA;4 patients with ASD and VSD;5 patients with PDA and VSD;3 patients with pulmonary atresia with intact ventricular septum（PA/IVS） and PDA,patent foramen ovale （PFO）;1 patient with aortic stenosis（AS） and PDA;1 patient with PDA and pulmonary sequestration.The sequence of interven-tional therapies were percutaneous radiofrequency assisted valvotomy and percutaneous balloon pulmonary valvuloplasty,percutaneous balloon aortic valvuloplasty,transcatheter closure of VSD,PDA,ASD,aortopulmonary collateral.Result：All patients were treated successfully without suvere complications.The results of the angiography and transthoracic echocardiography （TTE） showed that there was no residual shunt flow and the occluders fixed well after the procedure.In the 30 patients complicater with PS,the angiography after the procedure showed that the pulmonary valves worked perfectly and the systolic pressure gradient across the pulmonary valve decreased from （63.4±36.3）mmHg to （18.1±13.0）mmHg and the difference was significant （P0.01）;1 patient with AS,the angiography after the procedure showed that the systolic pressure gradient across the aorta valve decreased from 90mmHg to 50mmHg 3 patients with PA/IVS and PDA,PFO the angiography after the procedure showed that the pulmonary valves worked perfectly and the arterial duct closed two weeks later but the saturation of blood oxygen keep well.Conclusion：Interventional therapy is effective and safe in patient with congential heart diseases.However,transcatheter intervention for mul

关 键 词：先天性心脏病 小儿 复合心脏缺损 介入治疗 

分 类 号：R541.1[医药卫生—心血管疾病]