动脉导管内支架置入术治疗新生儿室间隔完整型肺动脉闭锁的疗效

Efficacy of arterial duct stenting in neonatal pulmonary atresia with intact ventricular septum

目的 评估动脉导管内支架置入术治疗新生儿室间隔完整型肺动脉闭锁的可行性和疗效.方法 选择2007年12月至2010年9月行动脉导管内支架置入术的室间隔完整型肺动脉闭锁新生儿11例.患儿年龄3～13（8.20±2.90）d,体重3.00～3.88（3.41±0.29）kg.根据血管造影结果选择冠状动脉支架和球囊,支架准确定位后充盈球囊扩张支架.术后观察患儿的血氧饱和度,检查超声心动图和正侧位胸片,记录支架的内径、位置,并且在支架术后1、3、6和12个月进行随访.结果 11例患儿均顺利置入支架.术前末梢血氧饱和度为（63.27±8.47）%,术前应用前列地尔后末梢血氧饱和度为（82.73±5.59）%,支架置入术后末梢血氧饱和度为（86.18±3.19）%,应用前列地尔后和支架置入术后末梢血氧饱和度均高于术前（P均〈0.01）,支架置入术后末梢血氧饱和度高于前列地尔应用后（P〈0.05）.术中测量动脉导管最窄内径为（1.69±0.37）mm,长度为（16.72±2.37）mm,置入支架内径均为4 mm,长度（20.18±3.40）mm.1例患儿在术后发生支架移位和血氧饱和度下降,并行B-T分流术;1例患儿随访期间在院外死亡,原因不明;1例患儿因术后4个月末梢血氧饱和度下降而行支架球囊扩张术;2例患儿分别在支架置入术后5和7个月行外科手术.结论 动脉导管内支架置入术治疗新生儿室间隔完整型肺动脉闭锁可行,且近期疗效良好。

Objective To evaluate the feasibility and efficacy of arterial duct stenting in neonates with pulmonary atresia and intact ventricular septum.Methods Eleven neonatal pulmonary atresia with intact ventricular septum patients received arterial duct stenting in our hospital from December 2007 to September 2010 were involved in this study. The average age was （8.20±2.90） days （ranged from 3 to 13 days）. The average weight was （3.41±0.29） kg （ranged from 3.00 to 3.88 kg）. The stents were selected according to digital subtracted angiography measurements. After checking for correct position by angiography, the balloon was inflated to expand the stent to desired diameter. Oxygen saturation was monitored, echocardiography was measured and stent diameter and location were observed by chest X-ray.Patients were followed up at 1, 3, 6 and 12 months post procedure. Results Stents were successfully implanted in all 11 patients. The preoperative peripheral oxygen saturation was （63.27±8.47）%, while increased to （82.73±5.59）% after alprostadil application and to （86.18±3.19）% after operation （all P〈0.01）.After the operation, the peripheral oxygen saturation was higher than alprostadil application （P〈0.05）.The intraoperative narrowest diameter of patent ductus arteriosus was （1.69±0.37）mm, the length was （16.72±2.37）mm. The internal diameter of implant stents was 4 mm, the length was （20.18±3.40）mm. After the operation, surgical B-T shunt operation was performed in one patient due to stent shift and pulse oxygen saturation decrease.One patient died post operation with unknown reason, another patient received stent balloon dilatation due to pulse oxygen saturation decrease at 4 months after the surgery. Pulmonary atresia with intact ventricular septum surgeries were performed in 2 patients at 5 and 7 months after stent implantation. Conclusion The neonatal pulmonary atresia with intact ventricular septum arterial stent implantation was a feasible and effective procedure and this method could be used as preferred treatment in pulmonary atresia and intact ventricular septum for neonates