Waight D J, Hijazi Z M
Section of Pediatric Cardiology, Pritzker School of Medicine, University of Chicago Children's Hospital, USA.
Adv Card Surg. 2001;13:143-67.
The advances in pediatric interventional cardiac catheterization have changed the therapeutic strategy for many patients with CHD. The procedure of choice for valvar stenosis, recoarctation, collateral vessel occlusion, and branch PA stenosis has moved from the operating room to the catheterization laboratory. Effective and safe transcatheter interventions now exist for closure of ASDs, VSDs, and PDAs and are considered viable alternatives to surgical closure. Other interventional catheterization procedures are currently being investigated to complement the surgical management of patients with complex anatomy, including covered stents for repair of aortic aneurysms, covered stents to complete the Fontan circulation in patients after a modified Glenn shunt, multiple stent designs for all vascular stenoses, percutaneous PA band, and transcatheter resurrection of the pulmonary valve in patients with severe pulmonary regurgitation. The rapid advances in the technology used in the catheterization laboratory will serve to improve the care we provide for our patients and extend the range of interventions performed outside of the operating room. Pediatric cardiologists and congenital heart surgeons must understand each other's interventional techniques and how they can be used in a coordinated fashion. This may involve staged therapy with transcatheter intervention before surgery, transcatheter interventions in the operating room, or modifications of surgical techniques to facilitate future interventional catheterization completion of a staged repair of complex disease. This interaction is essential for the optimal management of our patients with both straightforward lesions and complex anatomy.
小儿介入性心导管术的进展改变了许多先天性心脏病（CHD）患者的治疗策略。瓣膜狭窄、再狭窄、侧支血管闭塞和分支肺动脉狭窄的首选治疗方法已从手术室转移到导管室。目前存在有效且安全的经导管干预方法用于闭合房间隔缺损（ASD）、室间隔缺损（VSD）和动脉导管未闭（PDA），并且被认为是手术闭合的可行替代方法。目前正在研究其他介入性导管术，以补充复杂解剖结构患者的手术治疗，包括用于修复主动脉瘤的覆膜支架、用于改良格林分流术后患者完成Fontan循环的覆膜支架、用于所有血管狭窄的多种支架设计、经皮肺动脉环缩术以及严重肺动脉反流患者的经导管肺动脉瓣修复术。导管室所用技术的快速进展将有助于改善我们为患者提供的治疗，并扩大在手术室之外进行的干预范围。小儿心脏病专家和先天性心脏病外科医生必须了解彼此的介入技术以及如何以协调的方式使用这些技术。这可能涉及手术前的经导管分期治疗、手术室中的经导管干预，或修改手术技术以促进未来对复杂疾病分期修复的介入性导管术完成。这种相互协作对于我们对病变简单和解剖结构复杂的患者进行最佳管理至关重要。
