体肺动脉侧支血管堵闭术在全腔静脉肺动脉连接手术前后的应用

Application of transcatheter occlusion of aortopulmonary collateral vessels in patients before and after total cavopulmonary connection

目的评价体肺动脉侧支血管堵闭术在全腔静脉肺动脉连接手术(total cavopulmonary connection,TCPC)前后的应用价值。方法广东省心血管病研究所心儿科2006年5月至2014年10月于TCPC前、后应用经皮体肺动脉侧支血管堵闭术共治疗患者13例,其中10例于TCPC术前行侧支血管堵闭术,3例于术后进行堵闭。结果成功堵闭体肺动脉侧支血管16条,术中共应用Cook弹簧圈23个,塔型弹簧圈2个,一代血管塞4个,二代血管塞1个。共3例患者于外科术后出现咯血,其中2例行侧支堵闭术后咯血症状消失;另外1例堵闭术后4年因大咯血抢救无效死亡;其他10例患者于侧支堵闭术后行TCPC手术,术后顺利出院,随访结果满意。结论于TCPC术前、后行体肺动脉侧支血管堵闭术,可以缩短手术时间、简化手术操作、提高手术成功率,并且能够降低术后肺动脉压力,减少术后咯血症状发生,是一种安全、可行的方法 。

Objectives To evaluate the efficacy of transcatheter occlusion of aortopulmonary collateral vessels in patients before and after total cavopulmonary connection （TCPC）. Methods From May 2006 to October 2014, a total of 13 in-patients underwent transcatheter occlusion of aortopulmonary collateral vessels before and after TCPC in Department of Cardiac Pediatrics of Guangdong Cardiovascular Institute. Among them, transcatheter occlusion of aortopulmonary collateral vessels was attempted in 10 patients before TCPC,and 3 patients underwent this occlusion after the operation. Results Sixteen vessels were embolized successfully. There were 23 Cook coils, 4 plug I s, 1 plug Ⅱ and 2 tower-shaped coils used in occlusions. Three patients had hemoptysis after surgical operation, among whom, 2 patients＇ symptoms disappeared after occlusion, the other one died of massive hemoptysis 4 years after TCPC. The other 10 patients were discharged, and followed up without serious complications, the results were satisfactory. Conclusions Transcatheter occlusion of aortopulmonary collateral vessels before and after TCPC not only can shorten operating time, simplify the corrective surgery procedure, improve the success rate of surgery, but also can reduce the pulmonary arterial press and symptom of hemoptysis. It is a safe and feasible method.