摘要
目的 探讨经食管超声心动图（TEE）在新生儿危重型肺动脉瓣狭窄（CPS）非体外循环下经胸肺动脉瓣球囊扩张镶嵌治疗中的应用价值,总结操作要点.方法 回顾性分析15例在TEE引导下经胸肺动脉瓣球囊扩张成形术治疗新生儿CPS的镶嵌治疗,所有患儿均胸骨正中切口,于右室流出道距离肺动脉瓣环下约2 cm缝荷包线,在TEE引导下置入导丝和穿刺鞘管.确认穿刺针对准肺动脉瓣后,在钢丝引导下放入球囊扩张管进行扩张,TEE观察肺动脉瓣开放情况,测量跨瓣压差.结果 在TEE引导下,15例球囊扩张成形术均成功完成,未出现严重并发症.即时肺动脉跨瓣压力阶差（PTG）和右心室压力阶差均显著下降,与术前比较,差异有统计学意义（P＜0.01）.术后随访6～36个月,除1例患儿存在残余梗阻外,其余患儿生长发育良好,无再狭窄发生,三尖瓣反流量均不同程度减轻.结论 在TEE辅助下,镶嵌治疗新生儿CPS是安全有效的方法,具有创伤小、恢复快、手术时间短、无需体外循环辅助等优点.
Objective To investigate the clinical application value of transesophageal echocardiography（TEE） in off-pump hybrid therapy of transthoracic balloon pulmonary valvuloplasty for neonatal critical pulmonary stenosis（CPS）,and summarize the key points of the operation.Methods Fifteen neonates with CPS underwent hybrid therapy of transthoracic balloon pulmonary valvuloplasty guided by TEE were reanalyzed retrospectively.All patients were performed with a median sternotomy.A purse-string suture was placed in the right ventricular outflow tract 2 cm away from the pulmonary trunk,and then a guide wire and a puncture sheath pipe were inserted.The open situations of pulmonary valves and the transpulmonary valvular gradient pressure were observed by TEE after sequential dilations.Results Fifteen patients for balloon valvuloplasty were all successfully performed with the guidance of TEE,and no severe complications occurred.Both transpulmonary valvular gradient pressure（PTG） and right ventricular systolic pressure decreased significantly compared with those before operation（P ＜0.01）.All patients recovered well except for one with residual obstruction followed up at 6 months to 3 years after operation.Conclusions The hybrid therapy without extracorporeal circulation guided by TEE for neonatal CPS is safe and effective,which has the advantages of short operative time,less injury,quicker rehabilitation,etc.
出处
《中华超声影像学杂志》
CSCD
北大核心
2013年第10期861-864,共4页
Chinese Journal of Ultrasonography
基金
南京医科大学科技发展基金面上项目（2011NJMU142）
关键词
超声心动描记术
经食管
肺动脉瓣狭窄
婴儿
新生
镶嵌治疗
Echocardiography, transesophageal
Pulmonary valve stenosis
Infant, newborn
Hybrid therapy
