介入治疗心脏复合畸形疗效及安全性研究

The study of safety and efficiency of interventional therapy for complex cardiac defect

目的评估介入治疗心脏复合畸形的可行性,安全性及疗效。方法心脏复合畸形患者10(男6,女4)例,年龄5～53岁。其中房间隔缺损(ASD)并发肺动脉瓣狭窄(PS)2例、室间隔缺损(VSD)2例和动脉导管未闭(PDA)1例,PDA并发主动脉瓣关闭不全和PS各1例;VSD修补术后遗留ASD2例,ASD修补术后遗留PDA1例和刀刺伤致左室前侧术后遗留VSD1例。ASD或PDA并发PS者,先扩张肺动脉瓣,再行ASD或PDA封堵治疗。ASD并发VSD者,先封堵VSD,再封堵ASD。结果10例患者介入手术均1次成功。5例ASD封堵器的直径为8～38mm,2例膜部对称性VSD封堵器的直径为14mm和6mm,1例用10mm肌部VSD封堵器。2例PDA均用弹簧圈封堵。封堵PDA或VSD后造影无残余分流。封堵ASD后超声心动图示无残余分流。3例并发PS者,肺动脉瓣扩张术后即刻肺动脉跨瓣压差明显下降,由术前50、38、40mmHg分别降低为20、15和21mmHg。有1例PDA封堵弹簧圈脱落至肺动脉远端未能取出。随访1年肺功能正常,无肺不张。全部患者随访3个月～1年,无任何并发症发生。结论经导管介入治疗心脏复合畸形安全可行,近期疗效肯定。

AIM: To evaluate the safety, efficiency and feasibility of interventional therapy for complex cardiac defect. METHODS: 10 patients with complex cardiac defect (male 6, female 4,age from 5 to 53 years old) were involved the study, of whom 2 patients were atrial septal defects (ASD) associated with pulmonary valve stenosis(PS), 2 ASD associated with ventricular septal defects (VSD), 1 ASD associated with patent ductus arteriosus (PDA), 1 PDA associated with aortic valve regurgitation(AR),1 PDA associated with PS, 2 ASD after surgery repaired VSD, 1 PDA after surgery repaired ASD and 1 remnant VSD after surgery repaired stabbed anterior-lateral wall of LV. In patient with ASD or VSD associated with PS, Pulmonary valve was dilated firstly, then ASD or VSD was occluded. In patient with ASD associated with VSD, VSD was occluded firstly, then ASD was occluded. RESULTS: All 10 patients were treated successfully . The diameters of 5 ASD occluder devices were 8~38 mm, 2 membranous symmetry VSD occluder devices were 14 mm and 6 mm. 1 patient implanted a 10 mm muscular VSD device. 2 PDA were closed with coils . No residual shunt remained after operation evaluated by contrast and echocardiography. In 3 PS, the transpulmonary pressure gradient were reduction significantly decreased from 50, 38 and 40 mm Hg before PBPV to 20, 15 and 21 mm Hg after PBPV immediately respectively. In one patient with PDA, the coil fall off to the distal pulmonary artery and unable to take out, follow up a year, the function of the lung of the patient was normal and did not occur ateletasis. All patients follow up 3~12 months and no complication occur. CONCLUSION: Transcatheter treating complex cardiac defect is safe, feasible and efficacious in the near future.