先天性心脏病介入治疗1844例临床研究  

Clinical research on transcatheter intervention for congenital heart diseases of 1844 cases

作　　者：金梅[1] 韩玲[1] 王惠玲[1] 吴邦骏[1] 王霄芳[1] 郑可[1] 郭保静[1] 梁永梅[1] 肖燕燕[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所小儿心脏科,北京100029

出　　处：《心肺血管病杂志》2011年第5期364-370,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家"十一五"支撑计划(项目编号:2007BA105B03)

摘　　要：目的:通过对我院(科)自1987年4月至2011年2月,1844例先天性心脏病(先心病)介入治疗的分析,进一步了解先心病介入治疗近远期疗效和并发症发生情况。方法:对常见先心病室间隔缺损(VSD)、房间隔缺损(ASD)、动脉导管未闭(PDA)及肺动脉瓣狭窄(PS)常规行右心导管检查,记录各心腔大血管血氧资料及压力数据,计算肺循环血量与体循环血量比值(QP/QS);PDA、VSD分别做主动脉弓降部、左心室造影,以了解其大小、位置,ASD则通过超声心动图,了解其大小及边缘情况。选择适当堵闭器常规操作,将其放置合适位置,再经造影或超声心动图了解堵闭器位置及有无残余分流情况,若情况良好则释放堵闭器。对PS、主动脉瓣狭窄(AS)则在测量跨瓣压差基础上,通过右心室、左心室造影测量瓣环大小,以选择适当球囊扩张狭窄瓣环。结果:我科共完成先心病介入治疗1 844例,其中男性743例,女性1 101例;年龄0.3～72岁;体质量4.5～107 kg,平均23.9 kg。其中PDA共818例,ASD共600例,膜部VSD共190例,2例肌部VSD。PS 212例,AS 5例,室间隔完整的肺动脉闭锁(PA/IVS)所做的射频打孔+肺动脉瓣球囊扩张术2例,其他冠状动脉瘘及复合畸形等17例。总成功率为98.4%,严重并发症发生率0.59%(11/1 844)包括:蛛网膜下腔出血1例(VSD)、右心室流出道破裂1例(PS),心跳骤停1例(AS),以上3例均死亡。三尖瓣腱索损伤1例(PS),心律失常-完全房室传导阻滞3例(VSD 1例,ASD 2例),伞漂移4例。死亡3例,病死率为0.16%。对每例行先心病介入治疗的患者,要求其在术后1个月、3个月及6个月来院复查,随诊率达90%。讨论:经导管介入治疗先心病避免了开胸创伤大、全身麻醉及体外循环等高风险因素,封堵效果好,成功率高,术后恢复快,患者住院时间短。但严格掌握适应证,仍是手术能否成功的关键。Objective：To analyze the clinical efficiency and adverse effect of Interventional therapy during short-term and long-term follow-up.Methods：All patients were diagnosed by transthoracic echocardiography（TTE）,and underwent standard right heart catheterization.Left ventriculo-graphy and descending aortography were performed to judge the shape and size of the VSD and PDA.Results： Between April 1988 and February 2011,1 844 patients underwent the therapy of catheter closure at department of pediatric cardiology（743 males and 1101 females）,of whom.600cases were ASD,818 cases were PDA,192 patients with single VSD,212cases were Pulmonary valve stenosis（PS）,3 aorticstenosis（AS）,two PA/IVS,the other are coroncvry cutery fistula and complex cardiac defect.the patient＇s age ranged from 0.3 to 72 years and weight from 4.5 to 107 kg,median 23.9 kg.The technique success rate was 98.4%.3 patients were dead and the mortality was 0.16%.The severe complications rate was 0.59 %.Folllow-up data were obtained in 90% cases.Conclusion： Transcatheter interventional therapy of congenital heart diseases can be performed safely and successfully.Proper selection of patients and standard manipulation are essential to high successful closure rate and low complication rate.

关 键 词：先天性心脏病 导管 介入治疗 

分 类 号：R541.1[医药卫生—心血管疾病]