摘要
目的探讨经导管介入治疗复合型先天性心脏病的方法及疗效。方法63例复合型先天性心脏病患者中2例并发3种畸形,余均为2种复合畸形。经导管介入治疗原则:同期治疗应先行瓣膜球囊扩张术纠正瓣膜狭窄,其次行室间隔缺损(VSD)封堵术,再次行动脉导管未闭(PDA)封堵术,最后行房间隔缺损(ASD)封堵术;特殊情况时则遵循个体化原则。结果63例中,2例VSD并PDA患者因年龄小于3岁,体重不足10Kg,而进行分期介入治疗,其余患者均行同期介入治疗。63例患者均获成功,术中未发生任何重要并发症。19例ASD合并肺动脉瓣狭窄(PS)者,术后跨肺动脉瓣平均压差较术前明显降低(P<0.05)。4例Lutembacher综合征患者,术后二尖瓣瓣口面积均明显增加。术随访后3d、1个月、6个月,所有患者房室水平及大血管水平分流均消失,扩大的心腔进行性缩小,封堵器位置固定良好,无移位及脱落;X线检查显示肺血均明显减少,心电图检查未记录到严重心律失常。结论复合型先天性心脏病介入治疗虽较复杂,但只要术前严格掌握适应证,术中治疗策略合理、操作规范,同样可获得良好的治疗效果。
Objective To investigate the method and efficiency of interventional catheterization for combined congenital heart diseases. Methods Sixty-three patients with combined congenital heart diseases underwent simultaneous transcatheter therapy： 2 types heart defects （61 cases） and 3 types heart defects （2 cases）. The algorithm of transeatheter intervention was：more cases were underwent PBPV or PBMV at first followed by the occlusion of VSD,PDA and ASD successively. But individualization algorithm was to follow in few patients. Results Sixty-one patients were treated successfully at one time. Two patients with VSD and PDA were treated by stages because they were younger than 3 years and lighter than 10 Kg. All patients were treated successfully. No complications occurred during the procedure. In 19 patients with ASD and PS, the systolic mean gradient pressure across the pulmonary valve decreased after operation （P〈0.05）. In 4 cases of Lutembacher syndromes, the mitral valve orifice areas increased remarkably after procedure. All patients were enforced TTE,electrocardiography and X-ray on 3d,3 and 6 months after operation for the follow-up. No residual shunt and dislocation of the devices were found. The enlarged chambers heart were diminished progressively and all the occluders fixed well. At the same time, X-ray examination showed that pulmonary vascularity diminished significantly, there was no severe complication during the follow-up in all patients by electrocardiography. Conclusion Transcatheter intervention for combined Congenital heart diseases is more difficult. However, a satisfactory result can be obtained from suitable indications by TTE,proper algorithm of procedures and standardized manipulations.
出处
《重庆医学》
CAS
CSCD
2008年第23期2699-2700,共2页
Chongqing medicine
关键词
复合型先天性心脏病
介入治疗
封堵器
combined congenital heart diseases
catheterization
occluder
