复杂先天性心脏病改良Fontan手术后并发心源性脑栓塞一例报道并文献复习

Cardiogenic Cerebral Embolism after Modified Fontan Surgery for Complex Congenital Heart Disease:a Case Report and Literature Review

改良Fontan手术是目前治疗发绀型复杂先天性心脏病的主要手段之一。心源性脑栓塞占所有缺血性脑卒中的30%,而部分隐源性脑卒中也可能在之后被明确为心源性脑栓塞,且心脏结构异常导致的血流动力学改变、局部血栓形成或静脉系统至动脉系统的反常栓塞是心源性脑栓塞的主要发病机制。本文报道1例罕见的复杂先天性心脏病患者行改良Fontan手术后14年并发心源性脑栓塞,并结合既往文献,分析改良Fontan手术后并发心源性脑栓塞的机制、临床表现、影像学特征、治疗方案,以期为临床医生提供参考。

Modified Fontan surgery is one of the main treatments for complex congenital heart disease with cyanosis.Cardiogenic cerebral embolism accounts for 30%of all ischemic strokes,and some cryptogenic cerebral apoplexy may also be identified as cardiogenic cerebral embolism later,and the main pathogenesis of cardiogenic cerebral embolism is hemodynamic changes,local thrombosis or abnormal embolism from the venous system to the arterial system caused by cardiac structural abnormalities.In this paper,a rare patient with complex congenital heart disease complicated by cardiogenic cerebral embolism 14 years after modified Fontan surgery was reported.Combined with previous literature,the mechanism,clinical manifestations,imaging features,and treatment plan of cardiogenic cerebral embolism after modified Fontan surgery were analyzed,in order to provide reference for clinicians.