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目的:研究经导管同期治疗复合型先天性心脏病的可行性、方法及疗效。方法:2001-07-2007-10共30例复合型先天性心脏病患者,男11例,女19例。复合类型为:房间隔缺损(ASD)伴室间隔缺损(VSD)、动脉导管未闭(PDA)、肺动脉瓣狭窄(PS)分别为13例、7例、3例,伴二尖瓣狭窄(Lutembacher综合征)3例;VSD伴PDA2例;PS伴PDA2例;经导管治疗的原则:先行瓣膜球囊扩张术纠正瓣膜狭窄,其次行VSD封堵术,再次行PDA封堵术,最后行ASD封堵术。术后48 h、1个月、6个月分别行经胸超声心动图(TTE)、X线及心电图检查评价治疗效果。结果:30例复合型先天性心脏病患者均一次性介入治疗成功,术中未发生任何重要并发症。术后即刻TTE和造影示ASD、VSD、PDA所有封堵器位置良好,无残余分流。ASD和PDA伴肺动脉瓣狭窄(PS)5例,跨肺动脉瓣平均压差由术前(56.4±15.2)mmHg(1 mmHg=0.133 kPa)下降至术后(13.1±8.9)mmHg,差异有统计学意义(P<0.05)。3例Lutembacher综合征患者,超声心动图测量二尖瓣口面积分别由二尖瓣球囊扩张术术前0.98、1.1和1.26 cm2增加到1.7、1.92和2.0 cm2,平均左房压分别由31、28和27降至9、8.5和7 mmHg。术后48 h、1个月、6个月经TTE检查示所有患者各水平分流均消失,扩大的房室内径进行性缩小,所有封堵器位置固定良好,无移位及脱落;同时X线检查,肺血明显减少,房室内径明显恢复;心电图检查无房室传导阻滞及左右束支阻滞;无其他并发症。结论:只要严格掌握适应证,术中采取适当的治疗策略,操作规范,复合型先天性心脏病同期介入治疗是可行的、安全的,可获得满意的临床效果。
Objective: To study the feasibility, method and efficacy of transcatheter treatment of complex congenital heart disease. Methods: A total of 30 patients with complex congenital heart disease were selected from 2001-07-2007-10. There were 11 males and 19 females. The composite type was ASD with ventricular septal defect (VSD), patent ductus arteriosus (PDA) and pulmonary stenosis (PS) in 13 cases, 7 cases and 3 cases with mitral stenosis (Lutembacher Syndrome) in 3 cases; VSD with PDA in 2 cases; PS with PDA in 2 cases; the principle of catheterization: valvular balloon dilatation to correct valve stenosis, followed by occlusion of VSD, PDA occlusion again, and finally ASD closure Blocking surgery. Postoperative 48 h, 1 month, 6 months, respectively, by transthoracic echocardiography (TTE), X-ray and electrocardiogram to evaluate the therapeutic effect. Results: Thirty patients with complex congenital heart disease were successfully treated with one-time intervention without any important complications during operation. Immediate postoperative TTE and angiography show ASD, VSD, PDA all occluders in good position, no residual shunt. In 5 cases of ASD and PDA with pulmonary stenosis (PS), the mean pressure across the pulmonary valve decreased from (56.4 ± 15.2) mmHg (1 mmHg = 0.133 kPa) to (13.1 ± 8.9) mmHg before surgery, the difference was statistically significant Significance (P <0.05). In 3 patients with Lutembacher’s syndrome, the mitral valve orifice area measured by echocardiography increased from 1.7, 1.92 and 2.0 cm2 respectively by 0.98, 1.1 and 1.26 cm2 before balloon balloon dilation. The average left atrial pressure was increased from 31, 28 and 27 down to 9, 8.5 and 7 mmHg. At 48 h, 1 month and 6 months postoperatively, all the patients’ trisection showed disappearance of all levels of shunt, and the size of the enlarged atrioventricular node decreased progressively. All the occluders were well fixed with no displacement and fall off. X-ray examination , Pulmonary blood was significantly reduced, a significant recovery of atrioventricular diameter; ECG without atrioventricular block and left bundle branch block; no other complications. Conclusion: As long as the indications are strictly controlled, the proper treatment strategy, standard operation and concurrent interventional therapy of complex congenital heart disease are feasible, safe and satisfactory clinical results.