小儿先天性心脏病复合畸形的经胸微创介入治疗  

Mini-invasive transthoracic intervention for compound congenital cardiac anomalies in children

作　　者：孙婷[1] 马伦超[2] 陆国梁[1] 肖霭仪[1] 谢少波[2] Sun Ting;Ma Lunchao;Lu Guoliang;Xiao Aiyi;Xie Shaobo(Department of Ultrasonograph, First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, China;Department of Cardiovascular Surgery, First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, China)

机构地区：[1]广州医科大学附属第一医院超声科,510120 [2]广州医科大学附属第一医院心脏外科,510120

出　　处：《中华小儿外科杂志》2019年第3期208-211,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的总结经胸微创介入治疗小儿先天性心脏复合畸形的经验和疗效。方法回顾性分析2015年3月至2017年5月接受经胸微创同期介入治疗的先天性心脏复合畸形患儿11例的临床资料。其中,男9例,女2例;年龄为(12.3±8.4)个月,范围在4~30个月;体重为(7.9±2.6)kg,范围在5.0~12.5kg。其中,房间隔缺损(atrial septalde fect,ASD)并发室间隔缺损(ventricular septal defect,VSD)5例,VSD并发动脉导管未闭(patent ductus arteriosus,PDA)1例,ASD并发PDA2例,VSD并发肺动脉瓣狭窄(pulmonary stenosis,PS)2例,ASD并发PS1例。做胸骨下端正中切口或胸骨左缘第三肋间1.5~2.0cm切口,在经食管超声心动图(transesophageal echocardiography,TEE)的监测、引导下,依顺序分别进行介入治疗。出院前及术后3个月复查心脏彩色超声、胸部X线片及心电图。结果11例患儿均一次性介入治疗成功。取胸骨下端正中切口9例,胸骨左缘第三肋间切口2例。手术时间为(81±14)min,范围在58~100min;术中出血量为(24±12)ml,范围在10~50ml。8例合并ASD患儿,均为继发孔型,置入封堵器直径为(7.5±1.2)mm,范围在6~14mm。8例合并VSD患儿,1例干下型,选用偏心封堵器,余7例膜周部,选用对称封堵器;置入封堵器直径为(6.2±1.0)mm,范围在5~9mm。合并PDA患儿3例,分别置入4~6、6~8、6~8mm型号的封堵器。术后TEE证实封堵器位置良好,无残余分流,对心脏瓣膜功能无影响。合并PS患儿3例,均行球囊扩张术,术后跨肺动脉瓣压差均降低至30mmHg以下。出院前及出院后3个月随访无不良并发症。结论经胸微创介入术在治疗小儿先天性心脏复合畸形方面安全可行,近期效果满意。Objective To evaluate the efficacy of mini-invasive transthoracic intervention for compound congenital cardiac anomalies in children. Methods From March 2015 to May 2017, a total of 11 children with compound congenital cardiac anomalies were recruited.There were 9 boys and 2 girls with an average age of (12.3±8.4)(4-30) months and an average weight of (7.9±2.6)(5.0-12.5) kg.There were 5 cases with atrial septal defect (ASD)+ ventricular septal defect (VSD)(n=5), VSD+ patent ductus arteriosus (PDA)(n=1), ASD+ PDA (n=2), VSD+ pulmonary stenosis (PS)(n=2) and ASD+ PS (n=1). A 1.5 to 2 cm incision was made in lower media sternotomy or third intercostal left parasternal.The sequences of interventional therapy were performed under the guidance of transesophageal echocardiography (TEE). Transthoracic echocardiography, fluoroscopy and electrocardiography were scheduled before discharge and 3 months later. Results All 11 cases underwent simultaneous interventional therapy successfully.The lower media sternotomy incision (n=9) and third intercostal left parasternal incision (n=2) were made in 2 cases.The average procedure time was (81±14)(58-100) min and the average amount of intraoperative blood loss (24±12)(10-50) ml.In 8 patients complicated with secundum ASD, the average diameter of occlude was (7.5±1.2)(6-14) mm.In 8 VSD-complicated patients, subarterial eccentric (n=1) and membranous symmetric (n=7) occludes were applied.The average diameter of occlude was (6.2±1.0)(5-9) mm.In 3 PDA-complicated cases, the size of occlude was 4-6, 6-8 and 6-8 mm respectively.Postoperative TEE indicated that all devices were successfully positioned without any residual shunt or impingement of atrioventricular valves.In 3 PS cases, balloon dilation decreased systolic pressure across pulmonary valve to a postoperative level of under 30 mmHg.No adverse complications occurred before discharge and 3 months later. Conclusions Mini-invasive transthoracic intervention is both safe and effective for compound congenital cardiac anomalies i

关 键 词：先天性心脏病 复合畸形 经胸微创 

分 类 号：R726.5[医药卫生—儿科]