采用双冠状动脉导丝法建立先天性心脏病介入治疗复杂路径轨道  

Application of double coronary artery guide-wires for establishing complex pathway of interventional therapy for congenital heart diseases

作　　者：邴振 刘娜 罗刚 王葵亮 纪志娴 泮思林 BING Zhen;LIU Na;LUO Gang;WANG Kuiliang;JI Zhixian;PAN Silin(Heart Center, Qingdao Women and Children's Hospital, Qingdao 266034, China)

机构地区：[1]青岛市妇女儿童医院心脏中心

出　　处：《中国介入影像与治疗学》2019年第9期535-539,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：国家自然科学基金(81770316);泰山学者工程专项经费

摘　　要：目的 探讨以双冠状动脉导丝法建立先天性心脏病(简称先心病)介入治疗复杂路径轨道的价值。方法 回顾性分析12例应用双冠状动脉导丝法建立介入治疗轨道的先心病患儿的临床资料,其中肺动脉闭锁伴室间隔缺损(PA/VSD)矫治术后肺动脉狭窄5例,法洛四联症(TOF)矫治术后肺动脉狭窄1例,大动脉转位(TGA)术后肺动脉狭窄1例,粗大体肺侧支(MAPCAs)3例,复杂型肺动静脉瘘1例及左冠状动脉回旋支-右心房瘘1例;分析先心病介入治疗复杂路径特点。结果 采用双冠状动脉导丝均成功建立输送轨道。对PA/VSD矫治术后肺动脉狭窄、TOF术后肺动脉狭窄、TGA术后肺动脉狭窄患儿成功进行球囊扩张,对MAPCAs、复杂型肺动静脉瘘及左冠状动脉回旋支-右心房瘘患儿均封堵成功,未出现瓣膜损伤、血管损伤、心包填塞及死亡等严重并发症。结论 以双冠状动脉导丝法建立先心病介入治疗复杂路径轨道方法安全、有效,可调控性强,能提供足够支撑力通过纡曲段,有利于提高介入治疗成功率,值得临床推广应用。Objective To explore the application value of double coronary artery guide-wire method in establishment complex pathway of interventional therapy for congenital heart diseases (CHD). Methods Clinical data of 12 children with CHD were retrospectively analyzed, including 5 patients with pulmonary artery stenosis after correction of pulmonary atresia with ventricular septal defect (PA/VSD), 1 with pulmonary artery stenosis after radical repair of tetralogy of Fallot (TOF), 1 with pulmonary artery stenosis after correction of transposition of great artery (TGA), 3 patients with pulmonary atresia with major aorta pulmonary collateral arteries (MAPCAs), 1 with complex pulmonary arteriovenous fistula (PAVF) and 1 with circumflex branch of left coronary artery-right atrial fistula. The characteristics of complex pathways for interventional treatment of CHD were analyzed. Results The pathways were successfully established with double coronary artery guide-wires in all patients. Balloon intervention was successfully performed in patients with pulmonary artery stenosis after correction of PA/VSD, radical repair of TOF and TGA underwent. Patients with pulmonary atresia with MAPCAs, complex PAVF and circumflex branch of left coronary artery-right atrial fistula underwent successfully occlusion. No major complication, such as valvular injury, vascular injury, pericardial tamponade or death occurred. Conclusion Double coronary artery guide-wire method is safe and effective for establishing complex pathway of interventional therapy for congenital heart diseases, which has strong flexibility and can provide sufficient support through tortuous pathway to improve the successful rate of intervention, therefore being worthy of clinical popularization and application.

关 键 词：冠状动脉导丝 先天性心脏病 介入治疗 轨道 

分 类 号：R541[医药卫生—心血管疾病] R815[医药卫生—内科学]