经导管同期治疗复合型先天性心脏病的安全性及疗效观察

Simultaneous transcatheter therapy of combined congenital heart disease

目的:研究经导管同期治疗复合型先天性心脏病的可行性、方法及疗效。方法:2001-07-2007-10共30例复合型先天性心脏病患者,男11例,女19例。复合类型为:房间隔缺损(ASD)伴室间隔缺损(VSD)、动脉导管未闭(PDA)、肺动脉瓣狭窄(PS)分别为13例、7例、3例,伴二尖瓣狭窄(Lutembacher综合征)3例;VSD伴PDA2例;PS伴PDA2例;经导管治疗的原则:先行瓣膜球囊扩张术纠正瓣膜狭窄,其次行VSD封堵术,再次行PDA封堵术,最后行ASD封堵术。术后48 h、1个月、6个月分别行经胸超声心动图(TTE)、X线及心电图检查评价治疗效果。结果:30例复合型先天性心脏病患者均一次性介入治疗成功,术中未发生任何重要并发症。术后即刻TTE和造影示ASD、VSD、PDA所有封堵器位置良好,无残余分流。ASD和PDA伴肺动脉瓣狭窄(PS)5例,跨肺动脉瓣平均压差由术前(56.4±15.2)mmHg(1 mmHg=0.133 kPa)下降至术后(13.1±8.9)mmHg,差异有统计学意义(P<0.05)。3例Lutembacher综合征患者,超声心动图测量二尖瓣口面积分别由二尖瓣球囊扩张术术前0.98、1.1和1.26 cm2增加到1.7、1.92和2.0 cm2,平均左房压分别由31、28和27降至9、8.5和7 mmHg。术后48 h、1个月、6个月经TTE检查示所有患者各水平分流均消失,扩大的房室内径进行性缩小,所有封堵器位置固定良好,无移位及脱落;同时X线检查,肺血明显减少,房室内径明显恢复;心电图检查无房室传导阻滞及左右束支阻滞;无其他并发症。结论:只要严格掌握适应证,术中采取适当的治疗策略,操作规范,复合型先天性心脏病同期介入治疗是可行的、安全的,可获得满意的临床效果。

Objective：To evaluate the possibility, methods and efficiency of simultaneous transcatheter therapy for combined congenital heart diseases. Method：Thirty patients （11 males and 19 females） with combined congenital heart diseases underwent simultaneous transcatheter therapy from July 2001 to October 2007. The types of the congenital heart defect combination were as follow： ASD and VSD （13 cases） ; ASD and PDA （7 cases） ; ASD and PS （3 cases） ; ASD and MS （3 cases） ; VSD and PDA （2 cases） ; PS and PDA （2 cases）. The algorithm of transcatheter intervention was： PBPV or PBMV at first followed by the occlusion of VSD, PDA and ASD successively. Transthoracic echocardiography （TTE）,X-ray examination and electrocardiogram （ECG） were done 48 h, 1 month, 6 months after the procedure to evaluate the outcome of the procedure. Result：All patients were treated successfully at one time, No complications occurred during and immediately after the procedure. There was no residual shut and all the occlusive device were found in the suitable site evaluated by means of TTE and X-ray right after the procedure. In 5 patients with ASD or PDA and PS, the systolic pressure across the pulmonary valve decreased from （56.4±15.2）mmHg to （13.1±8.9）mmHg （P〈0.05）. For 3 cases of Lutembacher syndromes, Mitral valve area increased from 0. 98, 1.1 and 1.26 cm^2 to 1.7, 1.92 and 2. 0 cm^2 , and the mean left atrial pressure decreased from 31, 28 and 27 mrnHg to 9, 8.5 and 7 mmHg. During 48 h to 6 months follow up, no residual shut and dislocation of the devices were found by TTE. At the same time, X-ray examination showed that pulmo- nary vascularity and enlargement of heart were diminished significantly, ECG examination showed no artrial ventricular block or right and left branch block. Conclusion.. Transcather intervention for combined congenital heart diseases is feasible and safe, satisfactory result can be obtained from suitable indications, proper algorithm of procedures and standardized manipulations.