切割球囊治疗儿童先天性心脏病术后肺动脉分支狭窄的临床评价  

Cutting balloon for the treatment of pulmonary branch stenosis remained after the surgery for congenital heart diseases in children:a clinical evaluation

作　　者：余志庆 赵鹏军 高伟[1] 黄美蓉[1] 李奋[1] 刘廷亮[1] 曹剑锋 孙爱敏[2] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心内科,200127 [2]上海交通大学医学院附属上海儿童医学中心放射科,200127

出　　处：《介入放射学杂志》2012年第8期621-624,共4页Journal of Interventional Radiology

摘　　要：目的评价切割球囊(cutting balloon,CB)治疗儿童先天性心脏病(先心病)术后肺动脉分支狭窄的疗效和可行性。方法收治3例先心病术后肺动脉分支狭窄患儿,其中2例为男性,分别为法洛四联症(TOF)术后残存左肺动脉狭窄和肺动脉闭锁(PA)、室间隔缺损(VSD)术后残存右肺动脉狭窄。1例女性,为"PA、VSD、动脉导管未闭(PDA)"术后残存左肺动脉狭窄。完善术前检查后行心导管介入治疗,分别测狭窄段压差和血管内径,选择合适CB扩张,根据扩张效果决定是否应用高压球囊再扩张。结果 TOF男性患儿和PA/VSD女性患儿先选择CB扩张后,予高压球囊再次扩张,血管内径由术前4.6 cm和4.2 cm分别增至5.8 cm和5 cm,压差由术前35 mmHg和12 mmHg分别降为19 mmHg和7 mmHg;PA/VSD男性患儿,应用CB扩张后,血管内径由术前4.8 cm变为5.6 cm,压差由术前12 mmHg降为6 mmHg。术中和术后均无肺水肿、肺出血等并发症发生。结论 CB治疗先心病术后肺动脉分支狭窄安全、有效,并发症少。Objective To evaluate the effectiveness and feasibility of cutting balloon （CB） therapy in treating pulmonary branch stenosis remained after the surgery for congenital heart diseases in children. Methods Three patients with pulmonary branch stenosis remained after ＂the surgery for congenital heart disease were admitted to authors＇ hospital. The patients included 2 males and one female. One male patient had residual left pulmonary branch stenosis and pulmonary atresia after the surgery for tetralogy of Fallot （TOF）. The other male patient had residual right pulmonary branch stenosis after the surgery for VSD. The female patient suffered from PA, VSD and PDA, after the surgery the left pulmonary branch stenosis remained. After careful preoperative examinations the cardiac catheterization as well as interventional treatment was carried out. Based on the gradient.pressure and the diameter of stenotic vessel suitable CB was used to perform angioplasty. The diameter of CB should be less than the diameter of the native vessel adjacent to impaired vessel. According to the result of dilatation, which was determined by angiography, a larger high- pressure balloon might be used to further dilate the vessel if the gradient pressure was still high. Results After the dilatation with CB, high-pressure balloon had to be employed in the male patient with TOF and in the female patient. The diameter of stenotic vessel in the male patient increased from preoperative 4.6 cm to postoperative 5.8 cm, while in the female patient it increased from preoperative 4.2 cm to postoperative 5.0 cm. The pressure gradient in the male and female patients decreased from preoperative 35 mmHg and 12 mmHg topostoperative 19 mmHg and 7 mmHg, respe-ctively. In the another male patient with PA and VSD, after CB dilatation the vascular diameter increased from preoperative 4.8 cm to postoperative 5.6 cm, and the pressure gradient decreased from preoperative 12 mmHg to postoperative 6 mmHg. No complications such as pulmonary edema or pulmonal7 h

关 键 词：肺动脉分支狭窄 经皮球囊血管成形术 切割球囊 并发症 

分 类 号：R726.5[医药卫生—儿科]