经导管同期治疗复合型先天性心脏病的疗效和安全性

Simultaneous Transcatheter Therapy of Combined Congenital Heart Disease

目的 :探讨经导管介入同期治疗复合型先天性心脏病的可行性、方法及疗效。方法 :13例患者 ,男 5例 ,女 8例。其中房间隔缺损 (ASD)合并肺动脉瓣狭窄 6例 ,ASD合并动脉导管未闭 (PDA) 4例 ,ASD合并膜部室间隔缺损 2例 ,PDA合并肺动脉瓣狭窄 1例。ASD合并其他畸形的患者 ,均先治疗其他畸形 ,最后行ASD封堵。PDA合并肺动脉瓣狭窄者 ,先行肺动脉瓣狭窄球囊扩张术 ,最后封堵PDA。结果 :13例患者均经导管一次治疗成功。ASD合并肺动脉瓣狭窄 6例 ,跨肺动脉瓣压差由术前平均( 13 8 3± 41 4)mmHg下降到术后平均 ( 12 0± 5 6)mmHg ,有显著性差异 (P <0 0 1)。所用ASD封堵器直径为 8～2 4mm。ASD合并PDA 4例 ,PDA最窄径 2～ 5mm ,封堵器直径为 6～ 8mm ;ASD封堵器直径为 8～ 2 8mm。ASD合并膜部室间隔缺损 2例 ,室间隔缺损直径分别为 3 5mm和 5 0mm ,用直径 6mm和 8mm的双盘状室间隔缺损封堵器封堵成功 ,所用ASD封堵器的直径为 12mm和 18mm。 1例PDA合并轻度肺动脉瓣狭窄 ,用聚乙烯球囊扩张、PDA用 4mm封堵器治疗成功。结论 :经导管介入同期治疗复合型先天性心脏病具有技术上的可行性、安全性和良好的治疗效果。

Objective:To evaluate the possibility, methods and efficiency of simultaneous transcatheter therapy for combined congenital heart diseases. Methods:Thirteen patients with combined congenital heart disease, including 5 males and 8 females,simultaneously underwent transcatheter therapy. Their ages were 2-37 years old.Six had atrial septal defect(ASD) and pulmonary stenosis (PS),4 had ASD and patent ductus arterious (PDA),2 had ASD and perimembranous vertricular septal defect (VSD),and one had PDA and PS.For patients with ASD and other deformities,ASD was occluded after the other deformities were treated.PS was dilated by balloon valvuloplasty,and then PDA was occluded in the patient with PS and PDA. Results:All patients were treated successfully at first attempt. In 6 patients with ASD and PS, the gradient pressure decreased from (138.3±41.4)mmHg before to (12.0±5.6)mmHg(p<0.01) after intervention. The diameters of ASD occluder implanted were 8-24 mm. In 4 patients with ASD and PDA, the narrowest diameters of PDA were 2-5 mm. In 2 patients with ASD and VSD, the diameters of VSD were 3.5 mm and 5.0 mm respectively: The diameters of occluder used were 6 and 8 mm for VSD and 12 and 18 mm for ASD. In patients with ASD, no residual shunt was found by the transthoracic echocardiography after the occluder was deployed. In the patient with PS and PDA, PS was dilated by valvuloplasty and PDA was occluded successfully. No complication occurred in the patients. Conclusion:Simultaneous transcatheser therapy for combined congenital heart diseases is feasible and safe, and has a favorable result.