心血管造影及超声检查在小儿先天性心脏病介入治疗中的联合应用研究

The combined use of cardioangiography and ultrasonography in interventional therapy for congenital heart disease in children

目的评价心血管造影与超声检查在小儿先天性心脏病介入治疗中的应用价值及其限度,探讨联合应用的指导意义。方法162例经超声筛选的先天性心脏病患儿,其中室间隔缺损(VSD)50例、动脉导管未闭(PDA)96例、肺动脉狭窄(PS)16例,介入术前均行心血管造影检查并测量缺损和狭窄处直径,重复超声检查,用配对t检验统计方法比较其差异;介入术后重复造影及超声检查评价封堵器位置、球囊扩张效果等。结果心血管造影及超声检查对小儿先天性心脏病均能明确诊断,对其部位、形态均能良好显示。上述两种方法测量50例VSD缺损直径分别为(4.93±2.73)mm和(5.66±2.77)mm,两者差异无统计学意义(P>0.05);测量96例PDA最窄处直径分别为(3.22±1.45)mm和(3.96±1.42)mm,两者差异有统计学意义(P<0.05);测量16例PS瓣环直径,分别为(16.16±4.26)mm和(17.94±5.50)mm,两者差异无统计学意义(P>0.05)。VSD术中超声监测发现封堵器影响瓣膜开闭者9例,并经超声监测下重新调整位置直至正常。VSD及PDA介入术后造影共发现残余细小分流7例,24h后超声检查残余细小分流全部消失。16例PS患儿经球囊扩张后,右室-肺动脉压差均较术前下降超过50%,达到临床治疗标准。162例中除3例外均成功施行介入治疗。结论在小儿先天性心脏病介入治疗中病变直径测量与封堵器选择需以造影检查为标准,但在介入术前病例筛选及术后疗效评价中,超声检查更具优势。

Objective To assess the respective value and limitation of cardioangiography and ultrasonography in interventional therapy for congenital heart disease in children, and to discuss the clinical significance of the combined use of both examinations. Methods A total of 162 children with congenital heart disease, screened by ultrasonography, were enrolled in this study. The disorders included VSD （n = 50）, PDA（n = 96） and PS（n = 16）. Before the interventional therapy all the cases accepted cardioangiography and ultrasonography examinations, and the diameter of the abnormal passage was measured. The difference in the diameter between two examinations was compared and statistically analyzed by using paired t test. All the cases accepted both examinations after the interventional therapy to check the location of the occluder and the result of balloon dilatation. Results Both cardiovascular angiography and ultrasonography could make a definite diagnosis of congenital heart disease in children, and could well display the location and shape of the abnormalities. The diameter of VSD （n = 50） measured by cardioangiography and ultrasonography was （4.93 ± 2.73） mm and （5.66 ± 2.77） mm respectively, with no significant statistical difference existing between two methods （P〈0.05）. The diameter at the narrowest site of PDA （n = 96） measured by cardioangiography and ultrasonography was （3.22 ± 1.45） mm and （3.96 ± 1.42） mm respectively, with a significant difference existing between two methods （P〈0.05）. In 16 PS cases, the diameter of valvular ring determined on cardioangiogram and on ultrasonogram was （16.16 ± 4.26） mm and （17.94 ± 5.50） mm respectively, with no significant difference between two groups （P〉0.05）. During the operation of VSD, the monitoring ultrasonography revealed that the valvular opening and closing was interfered by the occluder in 9 cases, so the occluder was re-adjusted till it was fixed to proper position. After the interventional therapy for VSD and PDA, cardioangiography detected a small residual shunt in 7 cases, which completely disappeared 24 hours later on ultrasonography. After balloon dilation in all 16 children with PS the right ventricle-pulmonary artery pressure difference was reduced by more than 50% and the pressure figure reached the standard of clinical cure. The interventional procedure was successfully completed in all patients except for three cases. Conclusion In treating children of congenital heart disease with interventional procedures, the determination of the lesion’s diameter and the selection of the occluder should be based on cardioangiographic measurement, although ultrasonography is more helpful in making preoperative screening and postoperative evaluation.