我国胎儿先天性心脏病介入治疗的探索和展望

Exploration and prospect of interventional therapy for fetal congenital heart diseases in China

胎儿心脏介入治疗(FCI)病种主要包括室间隔完整的肺动脉瓣闭锁(PA/IVS)伴右心发育不良综合征(HRHS)、重度主动脉瓣狭窄(CAS)伴左心发育不良综合征(HLHS)及HLHS伴高度限制性房间隔缺损或房间隔完整(IAS/RAS)等3大类。我国最近3年开始FCI手术探索。由于人种与发病概率差异,胎儿肺动脉瓣成形术(FPV)在国内开展更为广泛。FCI是一项极度依赖超声医学、小儿心脏病、产科等多学科协同合作的手术技术,国内目前仍处于起步阶段。该文旨在介绍我国胎儿复杂先天性心脏病(先心病)宫内介入治疗发展现状和取得的初步成果,总结手术技术、手术适应证、围术期麻醉和管理等方面经验,探讨现阶段国内胎儿先心病介入治疗存在的问题和不足,为该技术在国内进一步健康、稳定、快速发展提供可能的发展方向,尤其是强调宫内干预必须符合伦理、进行遗传学筛查。

The fetal heart diseases that can be treated with fetal cardiac intervention(FCI)mainly include the following three categories:①pulmonary atresia(PA)or critical pulmonary stenosis(CPS)with intact ventricular septum(IVS)associated with hypoplastic right heart syndrome(HRHS),②critical aortic stenosis(CAS)associated with hypoplastic left heart syndrome(HLHS),and③HLHS complicated by intact atrial septum(IAS)or highly restrictive atrial septum(RAS).Clinical exploration of FCI has been carried out since 2016 in China.Because of the differences in race and incidence probability,fetal pulmonary valvuloplasty(FPV)has more widely developed in China.FCI is a technique that is highly dependent on multi-disciplinary co-operation,including fetal echocardiography,pediatric cardiology,obstetrics,etc.At present,FCI is still in its start-up stage in China.This paper aims to introduce the state-of-the-art of intrauterine interventional therapy for fetal complex congenital heart diseases(CHD)and the preliminary results achieved in China,to summarize the technical points of FCI,indications,anesthesia and perioperative management,to explore the problems and shortcomings in aspect of interventional therapy for fetal CHD in China at the present stage,to point out a possible direction of further development of FCI in order to make the FCI technology further healthily,stably and rapidly develop forward in China.It is important to emphasize that the intrauterine intervention must be in accordance with the ethics and be subject to prenatal hereditary genetic screening.