小儿先天性心脏病介入治疗并发症的外科处理

Surgical treatment for complications of interventional treatment in children with congenital heart diseases

目的探讨先天性心脏病介入治疗后出现并发症而进行外科手术的适应证和手术时机。方法1997年6月至2007年6月我院有28例先天性心脏病的患儿在介入治疗后出现并发症而需要外科手术治疗，其中男12例，女16例，年龄为8个月～14岁，平均为（8．9±3．4）岁，体重为9～43妇，平均为（22．7±2．1）kg；房间隔缺损12例，室间隔缺损8例，动脉导管未闭8例。介入治疗并发症包括有：堵闭器脱落12例，单纯残余分流10例（其中残余分流合并溶血3例），Ⅲ度房室传导阻滞4例，堵闭器脱落合并心包填塞1例，堵闭器被三尖瓣腱索缠绕1例。有23例在介入手术后当天进行急诊外科手术，5例于术后48h内手术。外科手术中，堵闭器取出术20例，房间隔缺损修补12例，室间隔缺损修补8例，动脉导管未闭缝闭术8例。结果无住院死亡病例，经外科治疗后所有患儿均痊愈出院。术后复查心脏彩超无残余分流，而术前为Ⅲ度房室传导阻滞的4例患儿中，有3例恢复为窦性心律，1例转为Ⅱ度房室传导阻滞。结论介入治疗术前必须有准确的诊断，并且选择合适的病例进行；出现并发症后应及时外科手术；对出现Ⅲ度房室传导阻滞的病例，经保守治疗无效后尽快选择外科手术。

Objective To approach surgical indications and optimal timing for complications after interventional treatment in children with congenital heart diseases. Methods From June 1997 to June 2007, 28 patients with congenital heart diseases underwent surgical procedures due to complications after interventional treatment. Mean age was 8.9 ± 3. 4 years （ranging from 8 months to 14 years） ; mean weight was 22. 7 ± 2. 1 kg （ranging from 9 to 43 kg）. Twelve cases were males and 16 were females. The congenital heart diseases of the 28 cases included three pathological types as follows., atrial septal defect （12 cases）, ventricular septal defect （8 cases） and patent ductus arteriosus （8 cases）. Interventional complications included dislocation of occluder in 12 cases, residual shunting in 10 cases （three of whom complicated with mechanical hemolysis）, Ⅲ° atrioventricular block in 4 cases, dislocation of occluder complicated with pericardial tamponade in 1 case, and occluder twisted by tricuspid valves in 1 case. Eighteen patients underwent surgical procedures on the day of interventional treatment, while the other 10 underwent operations within 48 hours postoperatively. All the procedures included 20 cases of dislodgment of occluders, 12 cases of closure of atrial septal defect, 8 cases of closure of ventricular septal defect and 8 cases of closure of patent ductus arteriosus. Results All patients got recovery, with no death during hospitalization. The result of follow-up showed that all the patients got no residual shunting, 3 of 4 patients who got Ⅲ° atrioventricular block recovered to sinus rhythm. Conclusions It is necessary to make, accurate diagnosis before intervention in order to choose suitable patients for surgical treatment. Urgent operation should be done on patients with severe complications. For patients with the complication of Ⅲ°atrioventricular block, surgical treatment should he taken immediately when conventional treatment is no effective.