经食道超声引导经胸镶嵌手术治疗新生儿危重肺动脉瓣狭窄及闭锁

Transesophageal ultrasound-guided transthoracic mosaic surgery for critical pulmonary stenosis and atresia in neonates

目的探讨应用TEE全程引导监测实施经胸镶嵌手术治疗新生儿室间隔完整的危重肺动脉瓣狭窄及肺动脉闭锁的应用价值。方法收集室间隔完整的危重肺动脉瓣狭窄及肺动脉闭锁新生儿5例。术中应用TEE全程引导下行经胸肺动脉瓣球囊扩张成形术,评价即刻手术效果,术后密切随访。结果5例患儿均成功实施手术,患儿年龄(11.60±8.50)d,体重(3.30±0.72)kg,术前超声评估肺动脉跨瓣压差(94.5±13.5)mm Hg,术后即刻肺动脉跨瓣压差(15.40±8.52)mm Hg,所有患儿未见明显并发症。术后随访肺动脉瓣跨瓣压(9.09±5.14)mm Hg。结论TEE引导经胸球囊扩张镶嵌手术治疗新生儿室间隔完整的危重肺动脉瓣狭窄及肺动脉闭锁安全有效。

Objective To investigate the application value of whole-course guided transesophageal echocardiography(TEE)monitoring transthoracic mosaic surgery in the treatment of critical pulmonary stenosis and pulmonary atresia in neonates with intact ventricular septum.Methods Five neonates with severe pulmonary stenosis and pulmonary atresia with intact ventricular septum were collected.Transthoracic pulmonary valve balloon dilatation was performed under whole-course guidance of TEE during the operation.The immediate surgical effect was evaluated and with frequent postoperative follow-up visit.Results All the 5 children were successfully operated,whose age were(11.60±8.50)days and weight were(3.30±0.72)kg.Preoperative ultrasound assessment of pulmonary artery differential pressure(94.5±13.5)mm Hg,and immediate postoperative pulmonary artery differential pressure(15.40±8.52)mm Hg were performed.No obvious complications were observed in all the children.The follow-up pulmonary valve pressure was(9.09±5.14)mm Hg after the operation.Conclusions TEE-guided transthoracic balloon expansion in transthoracic mosaic surgery is safe and effective in the treatment of critical pulmonary stenosis and pulmonary atresia in neonates with intact ventricular septum.