法洛四联症外科矫治手术前后的介入干预治疗

Preoperative or postoperative percutaneous transcatheter interventional treatments in patients with tetralogy of Fallot

目的：评价经导管介入治疗措施对法洛四联症（tetralogy of Fallot,TOF）外科矫治术的辅助治疗价值.方法：对我科2010年10月至2013年12月住院的27例,和作者在外院完成的3例TOF经导管介入治疗进行总结分析.结果：男性20例,女性10例,年龄8个月～49岁,平均4.3岁.外科矫治术前行体-肺侧枝血管（major aorto-pulmonary collateral arteries,MAPCAs）栓塞术17例、肺动脉瓣球囊扩张术（percutaneous balloon pulmonary valvuloplasty PBPV）4例;因术后肺出血急诊行MAPCAs栓塞术4例,术后左心衰行MAPCA-肺静脉瘘瘘口封堵1例、肺动脉分支狭窄球囊扩张（percutaneous balloon pulmonary arterioplasty PBPA）3例、PBPV1例.介入治疗均达到预期效果,未发生与操作相关的并发症,l例根治术后,肺出血患者行MAPCAs栓堵术后肺出血改善,但死于感染性心内膜炎,其他病例均痊愈出院.结论：TOF外科矫治术前、术后的介入治疗,可减少TOF根治手术风险并改善预后.

Objective：To evaluate the valuations of preoperative or postoperative interventional percutaneous transcatheter treatments in patients with tetralogy of Fallot （TOF）.Methods：Thirty patients with TOF were treated by transcatheter embolization of major aorto-pulmonary collateral ateries （MAPCAs） or dilation of stenotic pulmonary artery and valve before and after surgical procedures.the data were retrospectively analysed.Results：The patients included 20 male and 10 female,the average ages were 4.3 years （6m-49y）.Embolization of MAPCAs in 17 petients and dilation of stenotic pulmonary valve in 4 patients were performed before surgical procedures.Emergency emboiization of MAPCAs was performed in 4 petients because of pulmonary hemorrhage in perioperation period.After surgical procedures,embolization of fistula between MAPCAs and pulmonary veins in bilateral lungs because of congestive heart failure,dilation of pulmonary stenotic ateries and pulmonary valve in 4 and 1 patient respectively.There were no complications relevant to interventional treatment but 1 patient dead of surgical complication of infection endocarditis.Conclusion：I Preoperative or postoperative interventional treatments were effactive to decrease risks of complications and improve prognosis in patients with TOF.