超声引导下经胸微创封堵治疗先心病的远期随访结果分析

Minimally invasive transthoracic device closure of congenital heart disease navigated by transesophageal echocardiogram:Long-term follow-up results

目的总结超声引导下经胸微创封堵治疗儿童先心病的临床经验及随访结果,探讨其远期疗效及安全性。方法回顾性分析2007年3月至2017年12月在青岛大学附属妇女儿童医院心脏中心行食道超声引导下经胸微创外科封堵术治疗的先心病患儿临床资料,并进行长期随访。随访截至2020年12月,随访内容包括超声心动图、心电图、临床症状、并发症处理、预后情况。将室间隔缺损病例按照年龄、体重及封堵器类型进行分组,对常见并发症(如新发主动脉瓣反流、三尖瓣反流及右束支传导阻滞)的发生率进行组间比较。结果本研究共纳入752例患儿,其中室间隔缺损727例,封堵成功691例(95.05%);房间隔缺损19例及联合畸形6例均封堵成功。684例获随访,随访率为95.7%,随访时间3~13年,期间无一例死亡。室间隔缺损患儿随访结果:53例残余分流中,48例自愈;8例新发主动脉瓣轻微或轻度反流中,2例好转;1例迟发性心包积液;新发三尖瓣轻度反流或由轻度进展至中度反流的34例患儿中,13例恢复正常,2例由轻度反流进展至中度反流;1例新发间歇性完全性房室传导阻滞患儿仍在随访中,2例一过性完全性房室传导阻滞已恢复;2例新发左束支传导阻滞的患儿中,1例恢复;38例新发右束支传导阻滞患儿中,5例恢复正常。偏心型及鞍型封堵器更易出现主动脉瓣反流(P<0.05),而不同封堵器类型中,三尖瓣反流与右束支传导阻滞的发生率差异无统计学意义(P>0.05),不同年龄组、不同体重组中常见并发症的发生率差异无统计学意义(P>0.05);复合畸形中,1例新发主动脉瓣轻度反流并在1年后恢复正常。结论先心病经胸微创封堵技术结合了体外循环手术和导管介入手术治疗的优势,远期随访提示安全、有效,但需进行全生命周期随访和健康管理。

Objective To summarize the clinical experience and long-term follow-up result of minimally invasive transthoracic device closure(MITDC)of congenital heart disease(CHD),and evaluate its long-term efficacy and safety.Methods A retrospective review was performed on the clinical data of patients with CHD undergoing MITDC navigated by transesophageal echocardiogram(TEE)from March 2007 to December 2017.The patients were continuously followed up by December 31,2020,with clinical symptoms,echocardiogram and electrocardiogram(ECG).The complications,countermeasures and prognosis were then analyzed.Meanwhile,the patients of ventricular septal defect(VSD)were divided into different groups according to age,weight and device types,before comparison of common complications,such as emerging aortic regurgitation(AI),tricuspid regurgitation(TI)and right bundle branch block(RBBB).Results A total of 752 cases were enrolled in this study.There were 691(95.05%)of 727 VSD cases,19 atrial septal defect(ASD)cases and 6 cases combined with cardiac abnormalities undergoing successful closure.Follow-up in 684 patients(95.7%)ranged from 3 to 13 years without a single death.During the follow-up period,48 self-cured in 53 cases of residual shunts;2 in 8 cases of emerging slight or mild aortic regurgitation recovered;1 had delayed pericardial effusion;13 recovered and 2 developed to mild regurgitation in 34 cases of emerging mild tricuspid regurgitation or regurgitation progressing from mild to moderate;1 case of emerging intermittent complete atrioventricular block is being followed up and 2 cases of primary complete atrioventricular block recovered;1 in 2 cases of emerging left bundle branch block recovered;5 in 38 cases of emerging right bundle branch block recovered.The eccentric and saddle shaped devices were easier to lead to aortic regurgitation(P<0.05),whereas no correlation between device types and TI or RBBB occurrence rate was observed(P<0.05).There was no significant differences on the common complications between different age and weight groups(P<0.05).Among the 6 cases combined with cardiac abnormalities,1 with emerging mild aortic regurgitation recovered after 1 year.Conclusion MITDC of CHD integrats the advantages of both traditional surgical closure under cardiopulmonary bypass operation and transcatheter device closure.Currently the long-term follow-up result is promising,while patients still require life cycle follow-up and health management.