室间隔完整型肺动脉瓣闭锁介入治疗与外科手术的临床对比

Comparison of transcatheter intervention and surgical operation in pulmonary atresia with intact ventricular septum

目的 比较经导管介入治疗与外科手术的室间隔完整型肺动脉瓣闭锁（pulmonary valveatresia with intact ventricular septum,PA/IVS）临床治疗效果,探讨PA/IVS安全、有效的首期治疗方法 .方法 2006年1月至2009年5月,收治25例PA/IVS病儿中男20例,女5例.首期治疗年龄2天～8个月.体重2.1～6.7 kg.超声心动图提示右室三部分存在,右室轻～中度发育不良（三尖瓣Z值在-2～1.5）,无右室依赖型冠状循环.经导管介入治疗（介入组）8例,外科手术（手术组）17例.结果 两组成功率分别为88%和94%,两组各死亡1例.两组术后残余肺动脉瓣狭窄（PS）程度无明显差异,介入组机械通气时间及术后住院时间较之手术组短.全组随访3～36个月,介入组术后1例再次行球囊扩张,手术组术后行PS外科矫治和PS球囊扩张各1例,2例等待球囊扩张术.全组21例获双心室循环,介入组与手术组各1例因右心功能不全拟行双向格林手术.结论 对于右室轻～中度发育不良的PA/IVS,经导管介入治疗可以取代外科手术作为首期治疗方法 .

Objective To compare the results of transcatheter intervention （TI） and surgical operation （SO） in the primary treatment for pulmonary atresia with intact ventricular septum （ PA/IVS）. Methods From Junuary 2006 to May 2009, 25 patients （20 male,5 female） with PA/IVS were treated. The age at treatment was from 2 days to 8 months. The body weight was from 2.1 kg to 6, 7 kg. All patients had mild to moderate hypoplasia of the right ventricle （the Z-valvue of the tricuspid valve ： from - 2 to 1.5 ） with tripatite right ventricle and without coronary artery-right ventricular fistula. Eight patients underwent TI and 17 patients underwent SO. Results The primary procedure was successful in 7 patients （88%） in TI group and in 16 patients （94%） in SO group. There were 2 deaths （ 1 in each group）. There was no significant difference regarding residual pulmonary stenosis between two groups. The ventilation time and the days of hospital stay were shorter in TI group than in SO group. All the survivors were followed up for 3-36 months. One patient required repeat balloon dilation in TI group. While in SO group, one required reoperation and one required balloon dilation for PS, and 2 patients were waiting for balloon dilation. Twenty-one patients have achieved complete biventrieular circulation. Two patients were scheduled for Glenn shunt operation later （1 in each group）. Conclusion For PA/IVS patients with mild or moderate right ventricle hypoplasia, transcatheter intervention is a better alternative than surgical operation in the primary treatment.