小儿先天性心脏病术后大型体肺侧枝动脉的经皮介入封堵

Percutaneous occlusion of major aortopulmonary collaterals in children after cardiac surgery

目的评价小儿先天性心脏病术后大型体肺侧枝动脉经皮介入封堵的结果及总结相关经验。方法回顾性分析2013年1月至2017年2月所有先天性心脏病术后发现大型体肺侧枝动脉而行经皮介入封堵52例患儿的临床资料。其中男38例、女14例,月龄10.0(14.0)个月,体重8.6(4.4)kg。51例患儿为紫绀型先天性心脏病,1例患儿为非紫绀型。49例患儿行根治手术,3例患儿行Blalock-Taussig分流术。结果术后大型体肺侧枝动脉具有典型的临床表现:左房压增高、局灶性肺渗出、血性泡沫痰。封堵离手术结束时间为5(9)d,呼吸机辅助时间239(480)h,封堵后呼吸机辅助时间72(159)h,住ICU时间19(29)d。全组无死亡病例。结论术后造影可以诊断大型体肺侧枝动脉,早期介入封堵大型体肺侧枝动脉具有简单、安全、有效的优点。

Objective Tho evaluate the outcomes of early percutaneous occlusion of these residual major aortopulmonary collateral arteries after heart surgery. Methods This was a retrospective review of children undergoing early percutaneous embolization of major aortopulmonary collateral arteries after cardiac surgery. From January 2013 to February 2017, 52 consecutive patients with postoperative residual major aortopulmonary collateral arteries were treated with percutaneous embolization （38 males, 14 females; median age of 10.0 months, interquartile range 14.0 months; median weight 8.6 kg, interquartile range 4.4 kg）. Fifty-one patients were cyanotic and 1 patient was acyanotic. Forty-nine patients underwent corrective surgery and 3 patients underwent B-T shunt. Results Typical symptoms and signs of major aortopulmonary collateral arteries included： elevated left atrial pressure; focal lung infiltration, pink or bloodstained frothy sputum. The median time interval from cardiac surgery to percutaneous occlusion of major aortopulmonary collateral arteries was 5 （9） d, median duration of mechanic ventilation support since occlusion was 72 （159） h, mechanic ventilation support was 239 （480） h and median duration of intensive care unit was 19 （29） d. There was no death in this group. Conclusion Angiocardiography could be able to demonstrate the existence of postoperative major aortopulmonary collateral arteries. The early percutaneous occlusion appears to be simple, safe and effective.