经导管介入治疗儿童先天性冠状动脉-心腔瘘66例中远期随访  

Intermediate and long-term outcomes of transcatheter closure of congenital coronary cameral fistulas in 66 children

作　　者：李一凡[1] 李渝芬[1] 李俊杰[1] 谢育梅[1] 王树水[1] 张智伟[1] Li Yifan;Li Yufen;Li Junjie;Xie Yumei;Wang Shushui;Zhang Zhiwei(Department of Pediatric Cardiology,Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China)

机构地区：[1]广东省心血管病研究所、南方医科大学附属广东省人民医院(广东省医学科学院)心儿科,广州510080

出　　处：《中华儿科杂志》2024年第2期145-152,共8页Chinese Journal of Pediatrics

基　　金：广东省医学科研基金(A2021170);广州市科技计划项目(2023A04J0485)。

摘　　要：目的总结经导管介入治疗儿童先天性冠状动脉-心腔瘘(CCF)的经验及中远期随访结果。方法病例对照研究。选择2005年1月至2019年12月在广东省人民医院接受经导管介入治疗的66例先天性CCF患儿作为研究对象,收集并分析其临床基线资料、手术效果、术中及术后严重不良事件、随访结果及预后等资料。根据是否发生严重不良事件将患儿进行分组,比较严重不良事件组和无严重不良事件组一般情况及CCF特征的差异。组间比较采用独立样本t检验、χ^(2)检验或Fisher确切概率法。结果66例先天性CCF的患儿中男34例、女32例,年龄3.9(1.9,6.2)岁,体重15(11,20)kg。66例CCF均为中型或大型瘘管,其中近端型瘘管55例(83%),远端型瘘管11例(17%);瘘管起源于右冠状动脉38例(58%),起源于左冠状动脉28例(42%);合并冠状动脉瘤(CAA)40例(61%)。66例患儿中64例患儿完成封堵治疗,5例患儿发生6例次围手术期严重不良事件。围手术期手术成功率为92%(59/64),围手术期不良事件发生率为9%(6/64),其中2例患儿术中发生了2例次严重不良事件,包括手术相关死亡1例,急性心肌梗死1例;3例患儿术后随访1 d发生了4例次严重不良事件,包括急性心肌梗死2例、三尖瓣腱索断裂1例、封堵器脱落1例。共58例患儿完成中远期随访,随访时间9.3(6.5,13.4)年。9例患儿发生10例次严重不良事件,中远期严重不良事件发生率为17%(10/58),其中5例次并发症(1例次新发CAA、1例次主动脉瓣穿孔、1例次冠状动脉血栓形成、2例次新发三尖瓣脱垂伴重度反流)以及5例次大量残余分流(瘘管再通)。围手术期及随访期间,13例患儿发生16例次严重不良事件,51例患儿未发生严重不良事件。发生严重不良事件组患儿的大型瘘管[11/13比39%(20/51),P=0.005]、巨大CAA[10/13比14%(7/51),P=0.030]所占比例均明显高于无不良事件组患儿,肺动脉平均压明显高于无不良事件组患儿Objective To evaluate the intermediate and long-term outcomes and technical aspects of transcatheter closure(TCC)of coronary cameral fistulas(CCF)in pediatric patients.Methods This was a case-control study.All pediatric patients with CCF who underwent TCC between January 2005 and December 2019 were retrospectively reviewed.Data was collected from medical records,including demographic characteristics,procedural details,intraoperative and postoperative serious adverse events,follow-up results and prognosis.Patients with serious adverse events and without serious adverse events were compared regarding their clinical features and CCF characteristics.Comparisons between groups were performed with independent sample t test,chi-square test or Fisher exact test.Results A total of 66 CCF patients(34 boys,32 girls,3.9(1.9,6.2)years old,15(11,20)kg)underwent attempted TCC.All of the CCF were all medium or large fistulas including 55 proximal fistulas(83%)and 11 distal fistulas(17%).The CCF originated more frequently from the right coronary artery(38 cases(58%)),followed by the left coronary artery(28 cases(42%)).The incidence of coronary artery aneurysms(CAA)was 61%(40/66).Procedural treatment was achieved in 64 patients and procedural success was achieved in 59 patients(92%).Six(9%)serious adverse events occurred in 5 patients during the perioperative period.Acute complications included procedure-related death in one patient and acute myocardial infarction in one patient.Periprocedural complications occurred in 3 patients at one day postoperatively including acute myocardial infarction(2 cases),occluder detachment(1 case),and tricuspid chordae tendinae rupture(1 case).Clinical follow-up data were available in 58 of the 62 patients who underwent initial successful TCC with a follow-up period of 9.3(6.5,13.4)years.Ten adverse events occurred in 9 patients including 5 complications consisted of aortic valve perforation(1 case),coronary thrombosis(1 case),progressive aneurysmal dilation after reintervention(1 case),and new-ons

关 键 词：冠状动脉循环 放射学 介入性 随访研究 

分 类 号：R725.4[医药卫生—儿科]