杂交手术在复杂先天性心脏病治疗中的应用

The clinical application of hybrid procedure in the treatment of complex congenital heart diseases

目的 探讨杂交手术（hybrid procedure）在复杂先天性心脏病的治疗价值.方法 2009年7月至2013年9月,我院行Hybrid手术治疗45例复杂先天性心脏病.男26例,女19例;年龄1 1天～17岁,平均6.2岁.17例室间隔完整型肺动脉闭锁（PA/IVS）和2例肺动脉瓣狭窄（重度）合并三尖瓣关闭不全患儿采用胸骨正中切口,经食管超声心动图引导下,经右心室流出道行肺动脉瓣球囊扩张术.21例多发室间隔缺损（VSD）,其中7例合并房间隔缺损（ASD）,2例合并动脉导管未闭,患儿采用胸骨正中切口,经食管超声心动图引导下,先经右心室表面行肌部室间隔缺损封堵术,随后在体外循环心脏停搏下,常规方法修补其他部位缺损.5例法洛四联症患儿先经导管封堵侧支血管,随后立即在体外循环下常规行法洛四联症根治术.结果 2例PA/IVS患儿手术后死亡;43例顺利出院者均获随访.球囊扩张术者术后静息未吸氧经皮血氧饱和度0.88～0.96.13例跨肺动脉瓣压差≤30 mmHg（1 mmHg =0.133 kPa）,1例跨肺动脉瓣压差42 mmHg,1例为48 mmHg.多发VSD患儿未发现残余分流及封堵器移位,均无影响瓣膜功能等并发症.法洛四联症根治术后体-肺侧支造影显示无残余血流,无异位栓塞.结论 应用杂交技术治疗复杂先天性心脏病创伤小、手术风险降低、对于提高复杂性先天性心脏病的疗效、减少手术死亡有重要意义.

Objective To summarize the clinical experience of the hybrid procedure for the treatment of complex congenital heart disease.Methods From July 2009 to September 2013,45 cases of complex congenital heart disease underwent hybrid procedure in our hospital.Of them,there were 26 males and 19 females.They ranged from 11 days to 17 years（mean 6.2 years） in ages.The first group including 17 cases with pulmonary atresia with intact ventricular septum（PA/IVS）,2 cases with pulmonary valve stenosis （severe） and tricuspid regurgitation underwent balloon pulmonary valvuloplasty from the right ventricular outflow tract through median sternotomy incision and under the TEE guidance.The second group including 21 cases with multiple ventricular septal defect,include 7 cases with atrial septal defect and 2 cases patent ductus arteriosus underwent muscular ventricular septal defect occluder by right ventricular surface through median sternotomy incision and under the TEE guidance,then the conventional method was used for repairing other defect in the cardiac arrest with CPB.The third group including 5 cases with Fallot received transcatheter closure of the collateral vessels firstly,and then the conventional method was immediately used for correcting the deformity of Fallots with CPB.Results 43 patients were successfully discharged,two patients died after operation in the cases with PA/IVS.43 cases were followed up.SpO2 in the first group is 0.88-0.96 after operation.The transpulmonary valvular gradient pressure was below 30 mmHg in 13 cases,and which was 42 mmHg in 1 case and 48 mmHg in another case.No residual shunt or occlude shift was found in the second group after operation,neither was any complication which affected the valve function.Angiography showed no residual flow or ectopic embolism within the systemic-pulmonary collateral arteries.Conclusion Application of hybrid technology for the treatment of complex congenital heart disease was micro-traumatic and safe,which has great significance to improve the curative effect on the complex congenital heart disease and to reduce the operation mortality.