复杂性先天性心脏病的介入治疗

Interventional therapy for complex congenital heart disease

目的 探讨先天性心脏病 (简称先心病 )介入治疗在复杂性先心病中的应用。方法应用Rashkind球囊导管对 5 9例复杂性先心病患儿行球囊房隔造口术 (BAS) ;对 2例右室发育不良综合征患儿进行静态球囊房隔扩张造口术 ;对 1例在大动脉转位术后出现肺动脉吻合口狭窄的完全性大动脉转位 (TGA)的患儿 ,采用球囊扩张导管进行扩张 ;对 15例法洛四联症 (TOF)患儿进行经皮球囊肺动脉瓣成形术 (PBPV)、球囊血管成形术 ;对 18例合并主动脉至肺动脉侧支血管的患儿以及 5例B T分流术的患儿在外科根治术前采用弹簧圈进行侧支血管和分流管道的堵塞术 ;对 1例Fontan手术后的先心病患儿采用Amplatzer房间隔缺损 (简称房缺 )堵塞装置进行窗孔堵塞术。 结果4 6例TGA患儿BAS后动脉血氧饱和度 (SaO2 )由 0 5 7± 0 17上升至 0 76± 0 13(t =14 5 8,P <0 0 1) ,左右心房压差 2mmHg(1mmHg =0 133kPa) ,术后房缺 5～ 2 0mm ;10例肺动脉闭锁伴室间隔完整的患儿BAS后SaO2 变化不大 (t =1 5 7,P 0 0 5 ) ,左右心房压差 2mmHg ;TOF患儿经PBPV及球囊血管成形术后SaO2 平均上升 15 % ,肺动脉瓣狭窄解除 ;18例主动脉至肺动脉侧支血管堵塞术 ,14例效果良好被完全堵塞 ;5例B T分流管道堵塞术 ,全部封堵成功 ;1例Fontan手术后窗孔?

Objective The advances in i nt erventional cardiac catheterization have changed the therapeutic strategy for ma ny patients with congenital heart diseases. The aim of this study was to evalua te the role of therapeutic cardiac catheterization in the treatment of complex c ongenital heart diseases. Methods Balloon atrial septo stomy (BAS) was performed in 59 children using Rashkind balloon catheter. Stati c balloon dilatation of the atrial septum was performed in 2 children with hypop lastic right heart syndrome. One child with pulmonary artery stenosis at the su ture lines after arterial switch was treated with balloon dilatation. Percutane ous balloon pulmonary valvuloplasty (PBPV) and balloon angioplasty were performe d in 15 children with tetralogy of Fallot (TOF). Transcatheter coil embolizatio n was performed in 18 children with systemic to pulmonary collateral vessels and 5 children with B-T shunts before surgical procedures. Transcatheter closure of fenestration with Amplatzer septal occluder device was performed in 1 child w ho had undergone Fontan procedure. Results In 46 childre n with transposition of great arteries (TGA), the arterial oxygen saturation (Sa O 2) was increased from 0.57±0.17 to 0.76±0.13(t=14.58, P<0.01) after BAS. The pressure gradients across left and right atrium were less than 2 mmHg. The created atrial septal defects were 5-20 mm in size. In 10 childre n with pulmonary atresia with intact ventricular septum (PA/IVS), the arterial o xygen saturation did not change after BAS(t=1.57, P>0.05), but the pressure gradients across left and right atrium were less than 2 mmHg. In child ren with TOF, the arterial oxygen saturation was increased by 15 percent after P BPV and pulmonary valvular stenosis was relieved. In 14 of 18 children with sys temic to pulmonary collateral vessels and 5 children with B-T shunts, complete occlusion was accomplished and the procedures were successful. In the child who had undergone Fontan procedure, the fenestration was occluded successfully and no complication was observed. Conclusion In management o f complex congenital heart diseases, combination of surgical procedure and inter ventional catheterization therapy could be suggested to have better outcome.