复杂先心病双向Glenn术后奇/半奇静脉窃血介入封堵的疗效——附24例分析  

Effect of transcatheter occlusion of azygos/hemiazygos vein in patients with venous stealing after the bidirectional Glenn procedure-analysis of 24 cases

作　　者：戴辰程[1] 郭保静[1] 凌雁[1] 陈凌霄 金梅[1] Dai Chencheng;Guo Baojing;Ling Yan;Chen Lingxiao;Jin Mei(Pediatric Cardiology,Capital Medical University Affiliated Beijing Anzhen Hospital,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏科,100029

出　　处：《中华胸心血管外科杂志》2020年第3期156-161,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的观察并随访尚不具备全腔静脉-肺动脉吻合(TCPC)或根治手术条件的复杂先心病双向Glenn术后患者介入封堵窃血的奇/半奇静脉的疗效。方法回顾性分析2012年2月至2017年9月北京安贞医院行奇/半奇静脉封堵的双向Glenn术后的患者24例,观察并随访其疗效。结果21例行奇静脉封堵,其中1例同时行左上腔静脉封堵;2例行奇静脉及半奇静脉封堵;1例行半奇静脉封堵;6例同时行体肺侧支封堵。除1例直径为5.5 mm的奇静脉采用弹簧圈封堵外,其余奇静脉、半奇静脉及左上腔静脉均采用房间隔缺损封堵器完成介入封堵。封堵后血氧饱和度由0.78上升至0.85(P<0.05);封堵前后上腔静脉压力无上升(13.97 mmHg对14.22 mmHg,1 mmHg=0.133 kPa,P>0.05);无介入操作相关并发症发生。封堵术后随访2年患者血氧饱和度无明显下降,未出现颜面及双上肢水肿、胸腹壁静脉曲张、胸腔积液及腹腔积液。2例患者分别于介入封堵后1年及5年行TCPC手术。结论复杂先心病双向Glenn术后因奇/半奇静脉开放或左上腔静脉窃血致血氧饱和度下降且尚不满足TCPC手术指征的患者,在选择好适应证的前提下,即基础状态下肺动脉及上腔静脉压力≤20 mmHg,奇/半奇静脉封堵器释放前上腔静脉压力≤20 mmHg,针对致窃血的静脉行介入封堵可提高患者的血氧饱和度,改善生活质量,甚至部分患者通过解决静脉窃血,促进肺血管床发育,从而达TCPC手术指征。Objective To observe and follow up the effect of transcatheter occlusion of the azygos/hemiazygos veins in patients with complex congenital heart diseases and venous stealing after bidirectional Glenn procedure,who had not meet the criteria of total cavopulmonary connection(TCPC)or corrective operation.Methods This article analyzed retrospectively and followed up the effect of transcatheter occlusion of the azygos/hemiazygos vein in patients after bidirectional Glenn procedure hospitalized during February 2012 to September 2017.Results Transcatheter occlusions of azygos veins were performed in 21 patients and left superior vena cava(LSVC)was occluded in one of patients meanwhile.Azygos veins and hemiazygos veins were both occluded in two patients.One patient had the hemiazygos vein occluded.Aortic-to-pulmonary collaterals were occluded in 6 patients in the meantime.Atrial septal defect occluders were applied in the transcatheter occlusions of azygos veins,hemiazygos veins and LSVC,except one patient with an azygos vein which was 5.5 mm in diameter.Saturation was increased from 0.78 to 0.85 through occlusion(P<0.05).The pressure of superior vena cava(SVC)did not elevate and the mean pressure of SVC was13.97mmHg and 14.22 mmHg before and after occlusion(P>0.05).No complications associated with interventional procedures occurred.There was no significant decrease in blood oxygen saturation.Facial and upper limb edema,varicose veins in the chest and abdominal wall,pleural effusion and peritoneal effusion did not happen during follow up of 2 years.Two patients underwent TCPC operation one year and five years after interventional occlusion separately.Conclusion Transcatheter occlusion of azygos/hemiazygos vein or PLSVC was feasible in patients with complex congenital heart diseases and venous stealing after bidirectional Glenn procedure on the premise of choosing suitable indications.Suitable indications meant that the pressure of pulmonary artery and superior vena cava was less than 20 mmHg in the basal state,and the p

关 键 词：奇静脉 半奇静脉 介入封堵 双向GLENN术 

分 类 号：R541[医药卫生—心血管疾病]