先天性心脏病复合畸形介入治疗19例临床分析  

Clinical analysis of interventional therapy in 19 patients with congenital heart disease

作　　者：申国璋[1] 沈向前[2] 方臻飞[2] 唐建军[2] 

机构地区：[1]湖南省长沙市第四医院心内一科,410006 [2]中南大学湘雅二医院心内科,长沙410011

出　　处：《疑难病杂志》2015年第4期343-345,共3页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨先天性心脏病（CHD）复合畸形介入治疗的疗效和安全性。方法 CHD复合畸形患者19例,男11例,女8例,年龄5～36（15.2±10.7）岁,体质量25.6～55.8（32.2±26.1）kg;其中房间隔缺损（ASD）合并动脉导管未闭（PDA）5例,ASD合并肺动脉瓣狭窄（PS）6例,ASD合并室间隔缺损（VSD）3例,VSD合并PS 3例,PDA合并PS 1例,PDA合并B型预激综合征1例。介入治疗顺序为：PS球囊扩张术、VSD封堵术、PDA封堵术、ASD封堵术;PDA合并预激综合征先行射频消融治疗,再行PDA封堵术。结果 19例患者均一次性介入治疗成功,术中无严重并发症发生,术后造影和心脏彩超证实无明显残余分流,封堵器固定良好。10例合并PS患者的跨肺动脉瓣压差由术前的（50.6±17.2）mm Hg降至术后的（21.2±9.5）mm Hg（t=6.28,P〈0.01）。ASD合并其他畸形患者14例,均采用ASD封堵器,封堵器直径平均为（20.6±10.5）mm;PDA合并其他畸形患者6例,2例选用弹簧圈封堵,其余4例患者选用PDA封堵器,平均直径为（7.1±2.5）mm;VSD合并其他畸形患者6例,膜周部4例,并膜部瘤形成2例,均采用对称型VSD封堵器,封堵器直径平均为（9.5±3.2）mm。结论严格掌握适应证,制定合理的操作策略,CHD复合畸形介入治疗的疗效肯定,安全可行。Objective To investigate the efficiency and safety of interventional therapy for treatment of malformation in congenital heart disease（CHD）.Methods There were 19 cases of CHD complex malformation,male was 11 cases,female was 8 cases,age ranged from 5 to 36（15.2 ±10.7） years old,body weight ranged from 25.6 to 55.8（32.2 ±26.1）kg;CHD including atrial septal defect（ASD） combined with patent ductus arteriosus（PDA） in 5 cases,ASD with pulmonary valve stenosis（PS） in 6 cases,ASD with ventricular septal defect（VSD） in 3 cases,3 cases of VSD complicated with PS,1 cases of PDA complicated with PS,1 cases of PDA with type B pre-excitation syndrome.Interventional therapy in the order of：PS balloon dilation,VSD closure,PDA closure,ASD closure;PDA with pre-excitation syndrome was first with radiofrequency ablation therapy,then for PDA closure Results 19 patients were received 1 time successful interventional treatment,no serious complications occurred during the operation,postoperative angiography and cardiac ultrasound demonstrated no obvious residual shunt were occurred,and the occluder fixed well.In 10 cases of patients with PS,the systolic pressure across pulmonary valve were decreased from（50.6 ±17.2） mm Eg preoperative to（21.2 ±9.5） mm Hg postoperative（t=6.28,P0.01）.In 14 cases of ASD patients complicated with other malformations,all of them received ASD occluder therapy,occluder diameter with averaged of（20.6 ± 10.5） mm;in 6 cases of PDA patients complicated with other malformations,2cases received coil occlusion,the other 4 patients received with PDA septal occluder,average diameter of（7.1 ±2.5） mm;VSD combined with other deformities in 6 cases,4 cases in the membranous,and combined with membranous aneurysm formation in 2 cases,all of them received the symmetric VSD closure,the occluder diameter with averaged of（9.5 ±3.2） mm.Conclusion Strict indications with reasonable operation strategy,the interventional treatment of CHD complex malformation revealed cura

关 键 词：心脏缺损 先天性 心脏导管插入术 复合畸形 介入治疗 

分 类 号：R541.1[医药卫生—心血管疾病]