先天性心脏病复合畸形的临床介入治疗策略探讨及评价

Evaluation of Interventional Therapy in the Combined Congenital Heart Diseases:Analysis of 11 Cases

目的研究先天性心脏病复合畸形经心导管介入治疗的病例选择、手术方法、疗效、安全性及评价。方法选择2008年1月至2008年12月在本院接受同期介入治疗的11例复合型先天性心脏病患儿为研究对象。其中,男性患儿为3例,女性为8例,平均年龄为(4.08±2.64)岁,最小为5个月,最大为10岁。本组先天性心脏病复合畸形类型包括:3例室间隔缺损(ventricular septal defect,VSD)合并动脉导管未闭(patent ductus arteriosus,PDA),3例房间隔缺损(atrial septal defect,ASD)合并肺动脉瓣狭窄(pul monary stenosis,PS),2例房间隔缺损合并动脉导管未闭,1例房间隔缺损合并室间隔缺损,2例动脉导管未闭合并主动脉缩窄(coarctation of aorta,COA),其中1例为同期介入治疗。介入治疗复合畸形的顺序为:肺动脉瓣球囊扩张术或主动脉球囊扩张术、室间隔缺损封堵术、动脉导管未闭封堵术、房间隔缺损封堵术(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,取得受试对象的知情同意,并与试验患儿监护人签署临床研究知情同意书)。结果11例患儿均成功封堵,手术顺利。术后X射线心脏造影及彩超提示,封堵器成形好,未见残余分流。术中、术后均未见严重并发症。其中,1例室间隔缺损术后心电图提示不完全右束支传导阻滞,给予地塞米松治疗后,心电图复查正常。结论介入治疗单纯性先天性心脏病的技术目前比较成熟,成功率高,但复合型先天性心脏病同期进行介入治疗,其操作较复杂,技术难度较高。本研究证明,若掌握恰当手术指征,制定合理操作策略,手术过程仔细、谨慎,介入治疗的可行性、安全性是较肯定的。

Objective To investigate methods of interventional catheterization for combined congenital heart disease and evaluate its efficacy and safety in children. Methods From January 2008 to December 2008, 11 cases （3 boys and 8 girls） underwent transcatheter intervention for combined congenital heart disease, including 3 patients with ventricular septal defect （VSD） and patent ductus arteriosus（PDA）, 3 with atrial septal defect（ASD） and pulmonary stenosis（PS）, 2 with atrial septal defect and patent ductus arteriosus, 2 with patent ductus arteriosus and coarctation of aorta （COA）, 1 with atrial septal defect and ventricular septal defect. The average age of all cases was （4. 08±2. 64） years old, the youngest was 5 months old, the oldest was 10 years old. The sequence of transcatheter intervention for the combined malformations was in order of pulmonary stenosis or coarctation of aorta, ventricular septal defect, patent ductus arteriosus and atrial septal defect. Informed consent was obtained from all participants. Results 11 patients were treated successfully. The results of the left ventricular angiography and transthoracic echocardiography after the procedure showed that there was no residual shunt flow and occluders fixed well. 1 patient showed incomplete right bundle branch block （IRBBB） after interventional treatment, and electrocardiogram （ECG） showed normal after treatment with dexamethasone. Conclusion Transcatheter intervention for combined congenital heart diseases could obtain satisfactory results with appropriate indications and procedure manipulations.