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目的结合介入器械和外科手术,实施“复合(Hybrid)”技术对先天性心脏病实施治疗。方法2005年3—10月,20例先天性心脏病患者接受了术中Hybrid技术治疗。球囊扩张组包括3例室间隔完整型肺动脉闭锁的新生儿和4例婴儿重度肺动脉瓣狭窄。缺损封堵组13例,包括10例房间隔缺损和3例多发室间隔缺损。正中或右侧腋下小切口进胸,在超声引导下经右室流出道置入球囊扩张管扩张肺动脉瓣或经右心房置入封堵器。2例多发室间隔缺损于体外循环下经三尖瓣置入封堵器。合并的其他心脏病变同期常规外科矫正,术式包括部分性肺静脉异位引流矫正、动脉导管结扎、冠状动脉旁路移植术等。术后心脏超声随访。结果患者全部顺利出院。1例婴儿重度肺动脉瓣狭窄术后2个月接受常规右室流出道成形术,1例多发肌部室间隔缺损因无法置入封堵器而转为常规术式。其余患者均顺利实施Hybrid术式。随访期内未发现介入器材相关的并发症。结论“复合”Hybrid技术可以避免体外循环,减少手术创伤,对于提高先天性心脏病的疗效具有重要的意义。
Objective To implement the “Hybrid” technique for the treatment of congenital heart disease in combination with interventional instruments and surgery. Methods From March to October 2005, 20 patients with congenital heart disease received intraoperative Hybrid technique. The balloon dilatation group consisted of 3 neonates with intact ventricular septal pulmonary atresia and 4 infants with severe pulmonary valve stenosis. Thirteen cases of defect occlusion group, including 10 cases of atrial septal defect and 3 cases of multiple ventricular septal defect. The middle or right axillary small incision into the chest, under the guidance of ultrasound through the right ventricular outflow tract into the balloon dilatation of the pulmonary valve or expansion of the pulmonary valve into the occluder. Two cases of multiple ventricular septal defect under cardiopulmonary bypass through the tricuspid valve into the occluder. Other concurrent mergers of other conventional heart surgery surgical correction, surgery, including partial ectopic drainage of pulmonary veins correction, catheterization, coronary artery bypass grafting. Postoperative cardiac ultrasound follow-up. Results All patients were discharged smoothly. One case of infantile severe pulmonary stenosis received routine right-ventricular outflow tract angioplasty 2 months after surgery. One case of multiple muscular ventricular septal defect was converted to conventional surgery because of impossibility of occluder implantation. The remaining patients were successfully implemented Hybrid surgery. No complications related to interventional devices were found during the follow-up period. Conclusion “Hybrid” Hybrid technology can avoid cardiopulmonary bypass and reduce surgical trauma, which is of great significance for improving the curative effect of congenital heart disease.