球囊房间隔造口术在复杂先心病Hybrid治疗中的临床价值研究

Value of balloon atrial septostomy in hybrid procedure for patients with complex congenital heart disease

目的探讨球囊房间隔造口术（BAS）在部分缺氧型复杂先心病外科与介入镶嵌治疗（Hybrid）中的临床应用价值。方法2000年9月至2008年2月，我院共有10例患者接受了BAS术，包括8例完全性大动脉转位（TGA）的婴儿（年龄2—50d），2例完全性肺静脉畸形引流（TAPVC）伴限制性房间交通的患者（年龄分别为60d和39岁）。8例患者在导管室于X线引导下接受BAS术、两例患者于监护室床旁经胸超声心动图（TTE）引导下完成BAS术，所有患者于BAS术当日或择期行外科根治术，跟踪随访至患者出院。结果所有患者行BAS术均获成功，无严重并发症发生。BAS术后患者房间隔缺损直径平均增加6．5mm（4～12mm）；术后患儿右房．左房平均压差由造口前的5．9mmHg下降至1．3mmHg；股动脉血氧饱和度平均由造口前的70．2％上升到81．4％。患者缺氧状况获得不同程度缓解，均存活至外科手术期。10例患者随后均成功行外科根治术，9例顺利出院，1例术后死于术后电解质紊乱。结论BAS术具有安全、快速、即刻有效等特点，能明显缓解缺氧症状。作为缺氧型复杂先心病Hybrid治疗的重要组成部分，能迅速稳定患者的危重状况，为外科手术赢得宝贵的时间和条件。

Objective To access the value of balloon atrial septostomy （BAS） in hybrid procedure for patients with complex congenital heart disease. Methods From September 2000 to February 2008, ten patients with complex congenital heart disease underwent BAS before surgical radical therapy with the guidance of X-ray or transthoracic echocardiography. Eight patients （ ages from 2 days to 50 days ） were complete transposition of great arteries（ TGA）, and two patients （age was 60 days, 39 years respectively） were total anomalous of pulmonary venous connexion （TAPVC） with restrictive atrial septal defect. Results All procedure achieved successfully, no severe complications occurred. The average oxygen saturation of femoral arteries of patients increased from 68.3% （ pre-procedure ） to 81.8% （ post-procedure ） significantly. The status in short of oxygen of all patients improved immediately. All patients survived until a surgical radical therapy. After successful operations, nine patients discharged, only one patient died of disorder of electrolyte. Conclusion BAS was a ideal palliate therapy for some cynotic complex congenital heart disease, and can play a important role in hybrid procedure for patients with complex congenital heart disease.