经胸超声心动图引导下经皮介入治疗儿童心脏复合畸形的安全性和有效性

Safety and efficacy of percutaneous intervention for children with combined congenital heart abnormality solely guided by transthoracic echocardiography

目的探讨经胸超声心动图（TTE）引导下经皮介入治疗儿童心脏复合畸形的安全性和有效性。方法纳入2015年9月至2017年6月在阜外医院行TTE引导下经皮介入治疗的心脏复合畸形患儿21名，对其临床资料进行回顾性分析。术中在TTE引导下经皮由输送器置入封堵器封堵缺损，或置入球囊扩张肺动脉瓣，术后即刻通过TTE评价手术疗效。患儿出院后定期门诊随访。结果患儿年龄（37.3±11.6）个月，男性9例，女性12例。室间隔缺损（VSD）合并房间隔缺损（ASD）4例，VSD合并动脉导管未闭6例，ASD合并动脉导管未闭6例，VSD合并肺动脉瓣狭窄2例，ASD合并肺动脉瓣狭窄3例。21例患儿在TTE引导下经皮介入治疗均获得成功，无患儿改为X线引导下经皮介入治疗或转外科行手术治疗。手术时间为（44.6±7.5）min，患儿均不需要输血或使用强心和镇静药物，术后无外周血管损伤或心包积液等并发症。患儿术后住院（3.5±0.6）d，均康复出院。术后随访（17.6±5.2）个月，患儿未发生房室传导阻滞、残余分流、封堵器脱落、血栓形成和新发瓣膜反流。结论TTE引导下经皮介入治疗儿童心脏复合畸形安全、有效，可避免X线和对比剂损伤。

ObjectiveTo investigate the safety and efficacy of percutaneous intervention of children with combined congenital heart abnormality solely guided by transthoracic echocardiography （TTE） .MethodsFrom September 2015 to June 2017, 21 children with combined congenital heart abnormality undergoing percutaneous interventional guided by TTE in Fuwai hospital were enrolled in our study, and the clinical data were retrospective analyzed. The atrial septal defect（ASD） closure, ventricular septal defect（VSD） closure, patent ductus arteriosus（PDA） closure or balloon pulmonary valvuloplasty were performed under the guidance of TTE. The procedural effect was evaluated by TTE after operation. The patients were followed up after discharged from the hospital.ResultsThe age was （37.3±11.6） months, and there were 9 male and 12 female patients. There were 4 cases with ASD and VSD, 6 cases with VSD and PDA, 6 cases with ASD and PDA, 2 cases with VSD and pulmonary stenosis, 3 cases with ASD and pulmonary stenosis. The operations were successfully performed in all patients. No one required extra X ray guidance or open heart surgery. The operation time was （44.6±7.5）min. All patients did not require blood transfusion, inotropic support, and analgesia. There were no complications such as peripheral vascular injury and pericardialeffusion after the operation. The length of hospital stay time was （3.5±0.6） days. All patients were recovered well. The follow-up was （17.6±5.2） months, and post-procedural conduction disturbances, residual shunts, occlude fall off, thrombosis, and new onset of valvular regurgitation were not observed in these patients.ConclusionPercutaneous interventional of children with combined congenital heart abnormality solely guided by TTE is safe and effective, and the procedure can avoid the potential injuries of X ray and contrast agent.