伴有体肺侧支血管的发绀型先天性心脏病患者镶嵌治疗的临床探讨  

An hybrid approach for cyanotic congenital heart disease with aortopulmonary collateral arteries

作　　者：黄凯[1] 韦斌[1] 郑宝石[1] 张炳东[1] 伍伟锋[1] 郭盛兰[1] 

机构地区：[1]广西医科大学第一附属医院心血管病研究所,南宁530021

出　　处：《岭南心血管病杂志》2014年第4期487-490,共4页South China Journal of Cardiovascular Diseases

基　　金：广西科技攻关项目(项目编号:桂科攻0993003C﹣28)

摘　　要：目的探讨伴有体肺侧支血管的发绀型先天性心脏病患者镶嵌治疗的可行性和效果。方法回顾性分析7例伴有体肺侧支血管的发绀型先天性心脏病镶嵌治疗患者的临床资料。全组患者于手术当天在导管室行主动脉造影和选择性体肺侧支血管造影,根据情况选择合适的弹簧圈对体肺侧支血管进行栓塞,随后立即移至外科手术室行外科矫治手术。结果 7例患者共发现体肺侧支血管15支,除其中的1支使用ev3公司可控性弹簧圈2枚栓塞外,其余均使用COOK公司非可控弹簧圈共20枚达到完全栓塞,顺利完成外科矫治手术。未出现介入治疗并发症,未发生体肺侧支栓塞后严重低氧血症,无矫治术后脱离体外循环机困难,外科根治术后未出现灌注肺、低心排血量综合征等严重并发症。术后无需行补救性体肺侧支栓塞。结论伴有体肺侧支血管的发绀型先天性心脏病患者镶嵌治疗是可行、有效的。Objectives To review the hybrid approach of combined collateral embolization with surgical repair for cyanotic congenital heart disease with aortopulmonary collateral arteries and to explore the feasibility and clinical skill of the hybrid approach.Methods Chnical data of 7 patients who underwent the hybrid approach were retrospectively analyzed.All the patients were diagnosed previously with cardiac computed tomograpy and cardioangiography.Before surgical correction,catheter embolisation was used to occlude aortopulmonary collaterals with different types of coils according to aortic angiography and selective collateral angiography.Results Of the 15 aortopulmonary collaterals in the 7 patients,1 completed embolisation by 2 detachable coils （ev3 corp.）,the others by 20 non-detachable coils （Cook corp.）.Successful hybrid approach was achieved in all cases.No comphcations including intervention complications,severe hypoxemia after catheter embolisation,difficulties of extracorporeal circulation,pulmonary overflow and low cardiac output syndrome after surgical correction were encountered.No remedial aortopulmonary collateral embohsation was needed.Conclusions The hybrid approach with coil occlusion of aortopulmonary collateral can be an effective and safe procedure in patients with cyanotic congenital heart disease.

关 键 词：心脏缺损 先天性 镶嵌治疗 体肺侧支血管 

分 类 号：R541.7[医药卫生—心血管疾病]