双向格林术后心血管造影特征分析  

Angiocardiographic characteristics of patients post bidirectional Glenn procedure

作　　者：闫朝武[1] 赵世华[1] 张戈军[1] 蒋世良[1] 李华[2] 徐仲英[1] 凌坚[1] 郑宏[1] 张岩[1] 王云[3] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院放射科,100037 [2]首都医科大学附属北京同仁医院心血管中心 [3]中国医学科学院北京协和医学院麻醉科,100037

出　　处：《中华心血管病杂志》2010年第11期1006-1009,共4页Chinese Journal of Cardiology

摘　　要：目的 分析双向格林术后并发症及心血管造影特征,为临床治疗提供依据.方法 38例先天性心脏病双向格林术后患者（男性24例,女性14例）接受心血管造影检查.年龄（7.8±5.6）岁,双向格林术至造影间隔时间为（4.1±1.9）年.所有患者均行上腔静脉及肺动脉造影,并测量肺动脉-上腔静脉连续压力.结果 38例患者肺动脉平均压力为（14.8±4.5）mm Hg（1 mm Hg=0.133kPa）,上腔静脉平均压力为（15.4±5.4）mm Hg;肺动脉到上腔静脉连续测压均无压力阶差.其中9例出现肺动脉压力升高,年龄为（6.6±4.7）岁,其上腔静脉平均压力为（22.9±5.1）mm Hg,肺动脉平均压力为（21.5±2.9）mm Hg.心血管造影提示14例患者[年龄（7.9±4.6）岁]出现静脉侧支血管,其中2例成功行经导管封堵术.侧支血管组上腔静脉压力[（17.8±7.2）mmHg比（14±3.6）mm Hg,P＜0.05]及肺动脉压力[（16.7±5.7）mm Hg比（13.7±3.4）mm Hg,P＜0.05]均高于无侧支血管组（n=24）.14例静脉侧支血管分布：后纵隔侧支12例,其中合并前纵隔侧支3例,合并中纵隔侧支1例;单独中纵隔侧支血管2例.2例患者肺动静脉瘘形成,其中单发囊状瘘和多发动静脉瘘各1例.2例患者存在体肺动脉侧支血管,均成功行经导管栓塞术.结论 双向格林术可引起多种并发症,心血管造影检查能够早期发现并指导治疗.Objective The study was performed to observe the angiocardiographic characteristics of patients post bidirectional Glenn procedure. Methods Thirty-eight consecutive patients [24 male/14 female, age 0. 9 - 28 （ 7. 8 ± 5.6 ） years] underwent bidirectional Glenn procedure were included in this study. Postoperative cardiac catheterization and angiocardiography were performed at 2 -7 （4. 1 ± 1.9）years after bidirectional Glenn procedure. Results Of 38 patients, pulmonary arterial mean pressure （PAMP）was （ 14. 8 ±4. 5）mm Hg（ 1 mm Hg =0. 133 kPa）, the mean pressure of superior vena cava（MPSVC） was （15.4 ± 5.4）mm Hg and no pressure gradient was detected. Elevated pulmonary arterial pressure was evidenced in 9 patients： PAMP was （21.5 ±2.9）mm Hg and MPSVC was （22.9 ±5. 1）mm Hg Systemic venous collateral channels （SVCC） were shown in 14 patients and PAMP [ （ 16. 7 ±5. 7）mm Hg vs. （ 13.7 ±3.4）mmHg, P〈0.05] and MPSVC [（17.8±7.2）mm Hg vs. （14.0±3.6）mm Hg, P〈0.05] were higher in SVCC patients compared to patients without SVCC. Transcatheter closure was successfully performed in 2 patients. Distribution of SVCC was as follows： Posterior SVCC in 12 patients （associated anterior SVCC in 3 patients and middle SVCC in 1 patient ）, middle SVCC in 2 patients. Pulmonary arteriovenous fistulae were presented in 2 patients. Aortopulmonary collateral arteries were presented in another 2 patients and were successfully occluded percutaneously. Conclusion Catheterization and angiocardiography play an important role in recognizing the complications post bidirectional Glenn procedure.

关 键 词：心血管畸形 心转流术 右 心血管造影 手术后并发症 

分 类 号：R686[医药卫生—骨科学]