手术治疗先天性心脏病介入术后严重并发症-附7例报告

Interventional therapy of congenital heart disease—A report of 7 cases

目的:探讨介入治疗先天性心脏病(CHD)术中及术后出现严重并发症的发生率、原因及防治方法。方法:对2006年3月至2013年12月,7例动脉导管未闭(PDA)、房间隔缺损(ASD)、室间隔缺损(VSD)介入封堵术及肺动脉瓣狭窄(PS)球囊扩张术中及术后,出现并发症而进行外科手术治疗的病例进行回顾性分析。包括严重主动脉瓣反流、三尖瓣反流各1例,封堵器移位1例,封堵器脱落3例,导丝折断1例。其中6例患者在全麻低温体外循环下行心脏直视手术,取出封堵器及导丝并矫治心脏畸形,1例在全麻常温非体外循环下取出封堵器并矫治心脏畸形。结果:7例患者均成功取出封堵器及导丝,心脏畸形矫治满意,体外循环手术中开放升主动脉全部自动复跳,顺利脱离体外循环机。心脏畸形矫正满意,恢复良好,无并发症。结论:CHD介入治疗是一种微创而有效治疗措施,但其并发症不容忽视,及时进行外科手术治疗可以避免病情恶化,矫治心脏畸形,恢复心脏功能。

Objective： To study the incidence,causes and treatment of severe complications in interventional therapy for congenital heart disease（ CHD）. Methods： A total of 7 patients who underwent surgical treatment of unsuccessful interventional treatment of PDA,ASD,VSD and PS from 2006 to 2013 were included in this retrospective analysis. Complications of interventional closure included severe aortic regurgitation in 1case,severe tricuspid regurgitation in 1 case,occluder displacement in 4 cases and guidewire fracture 1 case. Among the 7 patients,6 cases underwent open heart surgical occluder removal and cardiac defects correction under general anesthesia and hypothermia cardiopulmonary bypass. The other one underwent open heart surgical occluder removal and cardiac defects correction under general anesthesia and without extracorporal bypass. Results： All the children experience occluder and guidewire removal successfully,and defect correction with satisfactory outcome. All cases got cardiac resuscitation automatically and detached from cardiopulmonary bypass（ CPB） successfully after aortic unclamping under open heart operation. All the children survived with excellent results. Conclusion： Though interventional therapies are minor invasive and efficient for patients with CHD,their complications cannot be ignored. Proper and timely surgical treatment is an efficient approach to correct cardiac defects and avoid deterioration of heart function.