先天性心脏病合并肺动脉狭窄的造影方法分析

Strategies for pulmonary arteriography in complex congenital heart disease featuring pulmonary stenosis

目的:分析合并肺动脉狭窄的复杂性先天性心脏病选择性肺动脉造影方法。方法:经股静和/或动脉插管途径,采用不同方法对51例合并肺动脉狭窄的复杂性先心病行选择性肺动脉造影。结果:10例患者用导丝在心室内将猪尾导管末端打开,调整导丝进入肺动脉;34例患者通过剪切猪尾导管远端呈不同的弧度进入肺动脉;3例患者但因肺动脉瓣重度狭窄,5F导管无法通过,更换260cm长泥鳅导丝后交换4F导管进入肺动脉;4例患者经主动脉逆行进入心室后操纵导丝进入肺动脉。结论:根据心内结构及大动脉位置关系的变化采用不同的策略及器械能够成功进入肺动脉行造影及压力测定。

Objective： To describe the techniques of selective pulmonary arteriography and pressure measurement in complex congenital heart disease featuring pulmonary stenosis. Methods： Selective pulmonary arteriography was performed with different techniques in 51 patients with complex congenital heart disease featuring pulmonary stenosis. Results： The guidewire was preceded the tip of the pigtail catheter and adjusted into the pulmonary artery in 10 patients. Cut the distal tip of pigtail catheter facilitated manoeuvring of the catheter into the pulmonary artery in 34 patients. The 5 F catheter was unable to pass because of severe pulmonary stenosis in 3 patients, the guidewire was exchanged with 260 cm guidewire and 4 F catheter was advanced over the wire into the pulmonary artery. Guidewire and catheter passed through the aortic valve retrogradely, adjusted the guidewire into the pulmonary artery in 4 patients. No severe complication was observed. Conclusion： Based on the changes of the structure of the heart and the position of the great arteries, different strategies and instruments can be used to perform pulmonary angiography and pressure measurement successfully.