肺动脉瓣狭窄合并房间隔缺损的介入治疗

Transcatheter therapy of Fallot′s trilogy

目的 探讨肺动脉瓣狭窄合并房间隔缺损介入治疗的可行性、安全性及其疗效。方法选择临床诊断肺动脉瓣狭窄合并继发孔型房间隔缺损患者 11例 ,其中 ,男性 2例 ,女性 9例 ,年龄 4～38岁 ,平均 (2 2± 11)岁。 1例房水平双向分流和 2例右向左分流。 3例用双叶球囊和 8例用Inoue球囊行肺动脉瓣扩张成形术 ,3例用纽扣式补片和 8例用Amplatzer房间隔缺损封堵器关闭缺损。结果11例患者 10例经 1次导管术得到根治 ,1例肺动脉瓣扩张后诱发右室流出道痉挛 ,延迟 3个月后再行房间隔缺损关闭术成功 ;治疗后右室收缩压 (12 8± 72 )mmHg(1mmHg =0 133kPa)下降到 (5 6± 32 )mmHg(P <0 0 1) ,肺动脉瓣跨瓣压差 (113± 75 )mmHg降至 (2 5± 2 2 )mmHg(P <0 0 1) ,三尖瓣反流面积 (4 6± 2 0 )cm2 降至 (1 4± 0 9)cm2 (P <0 0 1) ,动脉血氧饱和度 0 92± 0 0 4上升到 0 96± 0 0 9(P <0 0 5 )。 3～ 6个月随访 ,有继发右室流出道心肌肥厚者右室压力继续下降到 (4 6± 14)mmHg(P >0 0 5 ) ,术中、术后未出现并发症。结论 先天性肺动脉瓣狭窄合并继发孔型房间隔缺损的法乐三联征介入治疗是可行的及安全的非外科根治方法 ,近期疗效肯定 ,远期效果有待随访。

Objective To investigate the feasibility, safety and effectiveness of Fallot′s trilogy interventional therapy. Methods 11 cases of Fallot′s trilogy patients (2 males and 9 females) underwent transcatheter therapy from July 1997 to October 1999. The mean age was 22±11 years (4 38 years). 2 of them has atrial septal right to left shunt, and 1 two way shunt. 8 cases underwent pulmonary valvuloplastry with Inoue balloon and 3 cases with bifoliate balloon. The atrial septal defects were occluded using buttoned device (3/11 cases) and Amplatzer (8/11 cases) septal occluder. Results All of 11 cases were treated successfully per catheter. One of the atrial septal defects was occluded 3 months after pulmonary valvuloplasty when atrial septal right to left shunt changed into left to right shunt. After therapy, right ventricular systolic pressure decreased from 128±72 mm Hg to 56±32 mm Hg ( P< 0 01), pulmomary valve systolic pressure gradient decreased from 113± 75 mm Hg to 25±22 mm Hg ( P< 0 01), measures of tricuspid regurgitation area decreased from 4 6±2 0 cm 2 to 1 4±0 9 cm 2 ( P< 0 01), arterial blood oxygen saturation went up to normal (from 0 92±0 04 to 0 96± 0 09, P< 0 05). Conclusion This study demonstrated that patients with Fallot′s trilogy may be treated by per catheter performance balloon pulmonary valvuloplasty. The atrial septal defects may occlude at the same time. Tanscatheter treatment of Fallot′s trilogy is a safe, effective method.