先天性心脏病临床处理时机及方式选择

How to select the timing and therapeutic approach for congenital heart disease

先天性心脏病病情轻重不一,选择适当的手术时机及治疗方式是获得最佳治疗效果和降低病死率的重要前提。肺动脉瓣狭窄在任何年龄段一般首选球囊扩张;而主动脉瓣狭窄无论是外科手术或介入治疗在儿童期均作为姑息治疗;局限的主动脉缩窄在幼儿期和儿童青少年期分别可通过球囊扩张或支架治疗。左向右分流的先心病如存在明显的肺高压则需早期干预,根据适应证相应地选择介入或外科手术。而复杂先心病则依据不同的肺动脉压力、肺动脉发育情况和是否存在低氧血症等决定手术的时间和手术方式。

The severity of congenital heart disease varies and how to select the appropriate timing and therapeutic approach is an important prerequisite to get the best efficacy and reduce the mortality. Percutaneous balloon pulmonic valvuloplasty is the first choice for the management of pulmonary valve stenosis in patients at any age. Either surgery or interventional thera- py for aortic valve stenosis is as a palliative treatment in childhood. Percutaneous balloon aortic valvuloplasty or stent im- plantation is the therapeutic approach for coarctation of the aorta in patients during early childhood and adolescence. Con- genital heart diseases with left to fight shunt, which develop a significant pulmonary hypertension, need early interventional treatment or surgery. As for the complicated congenital heart diseases, how to determine the timing of surgery and to select surgical approach are based on pulmonary artery pressure, size of pulmonary artery and the existence of hypoxemia.