Simpson J M, Moore P, Teitel D F
Department of Congenital Heart Disease, Guy's Hospital, London, United Kingdom.
Am J Cardiol. 2001 Jun 15;87(12):1372-7. doi: 10.1016/s0002-9149(01)01555-7.
The increased survival of low birth weight infants means that more of these infants may be candidates for catheter interventions. There are few data on the results of cardiac catheterization in this group. This study aimed to analyze, retrospectively, cardiac catheterization of infants weighing < or =2.5 kg, with emphasis on the results of interventions. The complication rates of interventional and diagnostic procedures were compared. One hundred eleven catheterizations were performed in 107 patients between 1985 and 1998. Thirty-one procedures were interventional. Balloon atrial septostomy (n = 16), balloon pulmonary valvuloplasty (n = 10), balloon pulmonary angioplasty (n = 1), and coil occlusion of collateral vessels (n = 3) were all performed successfully. One infant (3%) died while undergoing myocardial biopsy. The reintervention rate for isolated pulmonary valve stenosis was 25% (2 of 8) at 1 month, 57% (4 of 7) at 6 months, and 71% (5 of 7) at 1 year. Complications were significantly more frequent during interventional (13 of 31, 42%) than during diagnostic (13 of 80, 16%) procedures. The most common complications during interventions were arrhythmias (3 of 31, 10%) and respiratory deterioration (3 of 31, 10%). Cardiac catheterization was technically feasible in all patients. Balloon pulmonary valvuloplasty and atrial septostomy provided good palliation in this patient group. The mortality of interventional procedures was low. The high incidence of respiratory complications suggests that low birth weight infants should undergo elective ventilation for interventional cardiac catheterization.
低体重婴儿存活率的提高意味着更多此类婴儿可能适合进行导管介入治疗。关于这一群体心脏导管插入术结果的数据很少。本研究旨在回顾性分析体重≤2.5 kg婴儿的心脏导管插入术，重点关注介入治疗的结果。比较了介入性和诊断性操作的并发症发生率。1985年至1998年间，对107例患者进行了111次导管插入术。其中31次为介入性操作。球囊房间隔造口术（n = 16）、球囊肺动脉瓣成形术（n = 10）、球囊肺血管成形术（n = 1）和侧支血管线圈封堵术（n = 3）均成功实施。1例婴儿（3%）在心肌活检时死亡。单纯肺动脉瓣狭窄的再次介入率在1个月时为25%（8例中的2例），6个月时为57%（7例中的4例），1年时为71%（7例中的5例）。介入性操作期间的并发症（31例中的13例，42%）明显比诊断性操作期间（80例中的13例，16%）更频繁。介入期间最常见的并发症是心律失常（31例中的3例，10%）和呼吸功能恶化（31例中的3例，10%）。心脏导管插入术对所有患者在技术上都是可行的。球囊肺动脉瓣成形术和房间隔造口术为本患者群体提供了良好的姑息治疗。介入性操作的死亡率较低。呼吸并发症的高发生率表明，低体重婴儿进行介入性心脏导管插入术时应进行选择性通气。
