经皮介入栓堵双向Glenn术后扩张的奇静脉  

Percutaneous occlusion of the dilated azygous vein after bidirectional Glenn shunt

作　　者：凌雁[1,2] 沈向东[3] 范祥明[1,2] 张戈军[4] 金梅[1,2] 刘迎龙[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管病研究所小儿心脏中心,北京100029 [3]阜外心血管病医院小儿心脏外科 [4]阜外心血管病医院放射科

出　　处：《心肺血管病杂志》2012年第3期284-287,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市卫生系统高层次卫生技术人才培养计划(编号Z101107050210020);2011年北京市科技计划项目(编号211110074911001)

摘　　要：目的:总结经皮介入栓堵双向Glenn术后扩张奇静脉的结果。方法:8例复杂性先天性心脏病患儿,双向Glenn术后发现奇静脉和/或半奇静脉扩张,平均年龄(7.7±3.3)岁,平均体质量(24±6)kg,距双向Glenn手术1.0～4.7年,平均2.7年。入院时氧饱和度(SO2)平均(0.80±0.08)。心血管造影显示扩张的奇静脉和/或半奇静脉,平均内径(8±2)mm,与上腔静脉内径比值平均0.66±0.14。肺动脉的Mcgoon比值平均2.3±0.3,Nakata指数平均(248±75)mm2/m2,平均肺动脉压(PAP)和上腔静脉压(SCVP)均为(13.4±3.3)mmHg(1 mmHg=0.133 kPa)。1例合并左肺动脉(LPA)起始部中度狭窄。于基础麻醉下经皮导管栓堵奇和/或半奇静脉,1例同时行LPA狭窄部位球囊扩张。结果:栓堵术后SO2升高至平均〔(0.86±0.04),P<0.0001〕,PAP〔(12.9±3.4)mmHg,P=0.53〕和SVCP〔(12.7±3.2)mmHg,P=0.09〕无变化。4例于栓堵术后1 w至1年行全腔静脉-肺动脉连接术(TCPC)。4例随诊1～2年SO2无变化。结论:双向Glenn术后合并奇静脉和/或半奇静脉扩张、SO2降低,但无SCVP或PAP升高者,可经皮介入栓堵奇静脉和/或半奇静脉,以增加肺血流量,提高体循环SO2。Objective：To summarize the results of percutaneous occlusion of the dilated azygous vein after bidirectional Glenn operation.Methods： 8 patients aged（7.7±3.4） years were found dilated azygous or /and hemiazygous veins（2.7 years,1.0-4.7 years）after bidirectional Glenn shunt.Their oxygen saturation（SO2） were（（80±8） %,68%-92%）.Cardiac catheterization revealed the diameter of the dilated azygous or hemiazygous veins were（（8±2） mm,6-11mm）,the ration of to that of the super cava vein（SVC） were（（0.66±0.14）,0.48-0.84）.The Mcgoon and the Nakata index of pulmonary arteries were（（2.3±0.3）,2.0-2.9）and（（248±75） mm2/m2,118-305 mm2/m2）.The mean pulmonary pressure（PAP） and SVC pressure（SVCP） were both（13.4±3.3） mmHg（1 mmHg=0.133 kPa）.Moderated stenosis was found at the origin of the left pulmonary artery（LPA）in one patient.Results： The azygous or /and hemiazygous vein were successfully occluded percutaneously with coils in 5 cases,with duct occluders in 3 patients under general anesthesia.The stenosed LPA were dilated with balloon simultaneously.SO2 rose to（（86±4.3）%,P〈0.0001）immediately after the occlusions.But the PAP（（12.9±3.4） mmHg,P=0.53）and SVCP（（12.7±3.2） mmHg,P=0.09）were not changed.4 of the 8 cases were received Fontan procedures uneventfully one week to one year after the occlusions.2 cases waiting for Fontan operation,and 2 cases not suitable for Fontan were both followed up for 1 to 2 years,with SO2 not changed.Conclusions： Dilated azygous or /and hemiazygous veins in patients after bidirectional Glenn without SCVP or PAP hypertension,can be transcatheterly closured with coils or duct occluders,resulting in increased pulmonary blood supply and SO2.

关 键 词：复杂性先天性心脏病 双向GLENN手术 奇静脉 静脉侧枝 经皮介入栓堵 

分 类 号：R541.1[医药卫生—心血管疾病]