先天性心脏病介入治疗术中及围术期严重并发症分析

Analysis of intra-and peri-procedural severe complications induced by interventional therapy for congenital heart disease

目的探讨先天性心脏病(先心病)介入治疗术中及围术期严重并发症发生率、发生原因及治疗经验。方法回顾性分析北部战区总医院2013年1月至2017年12月接受介入治疗的先心病患者4704例,其中,动脉导管未闭(PDA)组1219例、房间隔缺损(ASD)组2170例、室间隔缺损(VSD)组948例、卵圆孔未闭(PFO)组103例、肺动脉瓣狭窄(PVS)组240例、主动脉瓣狭窄(AVS)组6例、主动脉缩窄(CoA)组14例及肺动脉狭窄(PS)组4例。分析患者介入治疗术中及围术期严重并发症发生情况。结果本研究共出现术中及围术期严重并发症46例,总发生率0.98%(46/4704),死亡率0.02%(1/4704),急诊手术率0.34%(16/4704)。PDA组并发症发生率0.98%(12/1219),ASD组0.55%(12/2170),VSD组2.00%(19/948),PVS组0.42%(1/240),AVS组16.67%(1/6),CoA组7.14%(1/14),PFO及PS组未发生严重并发症。VSD组并发症发生率显著高于ASD组(P<0.001)。上述患者中,16例接受急诊手术治疗,包括介入治疗4例、外科手术10例、介入治疗合并外科手术2例,除1例死亡外,其余患者经积极治疗后均预后良好。结论先心病介入治疗并发症发生率低,安全性好,但仍应严格把握介入治疗适应证,预防并发症的发生,对于VSD等并发症发生率相对较高的疾病,应注意提高介入操作技术水平,加强术前及术中评估,术后严密观察,进一步降低介入治疗相关并发症的发生风险。

Objective To investigate the incidence and cause of intra- and peri-procedural severe complications induced by interventional therapy for congenital heart disease(CHD),and to share our experience of prevention and treatment of these complications.Methods A total of 4704 patients with common CHD who received interventional therapy from January 2013 to December 2017 in our department were retrospectively analyzed.Patients were further divided into patent ductus arteriosus(PDA,1219 cases), atrial septal defect (ASD, 2170 cases),ventricular septal defect(VSD,948 cases), patent foramen ovale(PFO, 103 cases), pulmonary valve stenosis(PVS,240 cases),aortic valve stenosis(AVS,6 cases),coarctation of aorta(CoA,14 cases)and pulmonary stenosis (PS,4 cases)group.Results A total of 46 intra- and peri-procedural severe complications were encountered and the incidence rate was 0.98%(46/4704).The death rate was 0.02%(1/4704) and emergency surgery rate was 0.34%(16/4704).The complication rate of PDA, ASD, VSD, PVS, AVS and CoA group was 0.98%(12/1219), 0.55%(12/2170), 2.00%(19/948), 0.42%(1/240), 16.67%(1/6) and 7.14%(1/14), respectively.No severe complications were recorded in PFO or PS group.The rate of VSD group was signifi cantly higher than that of ASD group ( P <0.001).Among these patients, 16 cases received emergency operation including 4 intervention, 10 surgery and 2 intervention combining surgery.Except 1 death, all the patients with severe complications obtained good outcome.Conclusions Although the interventional therapy for CHD is characterized as low incidence of complications and good safety, clinicians should still strictly follow the indication of interventional therapy to prevent the occurrence of complications, especially for diseases with relatively higher complication rate such as VSD.To further decrease the risk of interventional therapy-related complications, interventional procedural skills should be continuously improved, pre- and intra-procedural evaluation should be reinforced and post-procedural conditions of patients should be intensively observed.