低龄低体重先天性心脏病患儿实施经胸微创介入术的临床研究

Clinical study of transthoracic minimally invasive cardiac surgery for low age-weight infants with congenital heart diseases

目的探讨经胸微创介入术治疗低龄低体重先天性心脏病（先心病璎幼儿的手术方式及疗效。方法2011年12月至2015年9月，在大连市儿童医院就诊的患儿中，80例有不同程度心肺功能不全的先心病患儿接受经胸微创介入术，体重3．10kg[平均（6．51±1．42）kg]，年龄1～13个月[平均（4．65±3．42户个月]。其中房间隔缺损18例、室间隔缺损29例、动脉导管未闭17例、右冠状动脉有房瘘1例，肺动脉瓣狭窄2例，联合畸形13例。均在全身麻醉非体外循环下，食管超声引导经胸置入封堵器闭合缺损或置入球囊扩张肺动脉瓣。结果80例患儿均治疗成功，随访1～45个月，行心电图、胸片及心脏彩超检查，无心律失常、残余分流、封堵器脱落、血栓、出血事件，无新发瓣膜反流。结论对低龄低体重先心病伴心肺功能不全的婴幼儿实施经胸微创介入术，只要掌握好方法及适应证，效果良好。

Objective To evaluate the surgical techniques and efficacy of transthoracic minimally invasive treatment for low age-weight infants with congenital heart disease （CHD）. Methods From December 2011 to September 2015, 80 infants with CHD [18 cases with atrial septal defect （ASD）, 29 cases with ventricular septal defect （VSD）, 17 cases with patent ductus arteriosus （PDA）, one case with right coronary artery- right atrium fistula, two cases with pulmonary stenosis （PS） and 13 cases with complex deformity] received transthoracic minimally invasive treatment in Dalian Children＇s Hospital. Of all these patients, the body weight was （6.51 ± 1.42） kg （3-10 kg）, and the average age was （4.65 ± 3.42） months （1-13 months）. Under general anesthesis without extracorporeal circulation, the occlusion device or the balloon was deployed under transesophageal echocardiography （TEE） guidance to close defect or to expand pulmonary valve. Results The operations were completed successfully in all the 80 cases. The 80 patients were followed up for 1 to 45 months. None of them showed heart disorder, residual shunt, occluder displacement, thrombus, hemorrhage or new valve regurgitation. Conclusion TEE-guided minimally invasive interventional therapy of CHD is effective and safe if operation indications and operations way are correct for low age-weight infants with cardiopulmonary insufficiency.