新生儿危重肺动脉瓣狭窄及室间隔完整型肺动脉瓣闭锁经导管介入治疗的短中期随访  

Short-and mid-term outcomes of transcatheter intervention for critical pulmonary stenosis and pulmonary atresia with intact ventricular septum in neonates

作　　者：李虹[1,2] 李渝芬[1] 李俊杰[1] 石继军[1] 张智伟[1] 徐衍梅[1] 张旭[1] 梁东坡[1] 蒋秋平[1] 

机构地区：[1]广东省人民医院广东省医学科学院广东省心血管病研究所心儿科,广州510100 [2]广东省妇幼保健院广东省妇女儿童医院心脏中心内科,广州511400

出　　处：《中华儿科杂志》2012年第12期925-928,共4页Chinese Journal of Pediatrics

基　　金：国家“十一五”支撑计划项目（2007BA105BOO）

摘　　要：目的评估经导管介入治疗新生儿危重肺动脉瓣狭窄（CPS）及室间隔完整型肺动脉瓣闭锁（PA／IVS）的安全性和疗效。方法收集2006年6月至2011年9月在广东省人民医院采用经导管介入治疗的CPS（19例）及PA／IVS（8例）新生儿27例。所有患儿均为瓣膜型狭窄或闭锁，无严重三尖瓣Ebstein’S畸形或严重右室及肺动脉瓣发育不良，PA／IVS无依赖右室的冠状循环。平均手术年龄（16．8±9．9）d，平均体重（3．3±0．5）kg。早产儿2例，体重分别为2．3妇和2．5kg。回顾性分析经导管介入治疗的技术成功率、即时疗效、并发症发生率、中期疗效及肺动脉瓣反流程度。结果26例成功完成介入治疗，平均右室压力明显下降，术前（112．0±21．0）mmHg（1mmHg=0．133kPa），术后（50．4±15．9）mmHg（P〈0．001），平均右室压力与主动脉压力比值明显下降，术前1．7±0．1，术后0．7±0．3（P〈0．001）。早期死亡1例，为PA／IVS患儿。术中5例出现并发症，心包积血3例，严重心律失常2例。术后5例因持续低氧血症延长使用前列腺素E，3～14d，无1例新生儿期需要外科体一肺动脉分流术。平均随访（33．5±18．3）个月（6个月～5年），21例无需再次介入治疗或外科手术，获一期根治。4例CPS患儿残余中度以上肺动脉瓣狭窄，其中3例于术后3个月再次行介入治疗术，1例等待再次介入治疗术。1例PA／IVS等待外科双向Glenn术。全组轻度肺动脉瓣反流18例，中度肺动脉瓣反流8例。结论新生儿CPS及PA／IVS采用经导管介入治疗是安全、有效的，可避免新生儿期外科手术。少部分患儿于婴儿期需再次经导管介入治疗。中期随访绝大部分患儿可获一期根治，轻度肺动脉瓣反流占大多数。Objective To assess the safety and efficacy of transcatheter intervention for critical pulmonary stenosis （ CPS ） and pulmonary atresia with intact ventricular septum （ PA/IVS ） in neonates. Method From June 2006 to September 2011, 27 neonates including CPS in 19 patients and PA/IVS in 8 patients underwent transeatheter intervention. All patients had membranous stenosis or atresia without severe Ebstein＇s anomaly and severe right ventricle and pulmonary valve hypoplasia, without right ventricle- dependent coronary circulation in PA/IVS. The mean age was （ 16. 8 ± 9. 9 ） d. The mean weight was （3.3 ± 0. 5 ） kg. Two of them were premature neonates, the weight was 2. 3 kg and 2. 5 kg, respectively. The procedural success, early outcome, complication rates, midterm results and pulmonary regurgitation were retrospectively studied. Result Twenty-six patients were successfully treated with transcatheter intervention. Right ventricular pressure fell from （ 112. 0 ± 21.0） mm Hg （ 1 mm Hg = 0. 133 kPa） to （50. 4 ± 15.9）mm Hg （P 〈0. 001 ）. The ratio of fight ventricular pressure and aortic pressure fell from 1.7±0. 1 to 0. 7 ±0. 3 （P 〈0. 001 ）. One patient died early of PA/IVS. Complication occmTed in 5 patients. Hemopericardium occurred in 3 patients, tachyarrhythmia in 2 patients. Five patients needed prolonged prostaglandin EI infusion for 3 to 14 days because of desaturalion after the procedure. No patient needed surgery in neonatal period. At a mean follow-up of （33.5 ± 18.3） months （from 6 months to 5 years） , 21 patients had no further transcatheter or surgical intervention. Four patients with CPS had moderate to severe residual pulmonary stenosis after the procedure, 3 of them underwent a second balloon dilation at 3 months of follow-up, the other one was waiting for the second balloon dilation. One patient with PA/IVS was waiting for a bidirectional Glenn procedure because of chronic right ventricular failure. Mild pulmonary regurgitation occurred in 18 patie

关 键 词：肺动脉瓣狭窄 肺动脉瓣闭锁 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]