Zhou Ai-qing, Wang Rong-fa, Gao Wei, Yu Zhi-qing, Li Fen, Huang Mei-rong
Xinhua Hospital, Shanghai Children's Medical Center, Shanghai Second Medical University, Shanghai 200127, China.
Zhonghua Er Ke Za Zhi. 2004 Nov;42(11):813-6.
The advances in interventional cardiac catheterization have changed the therapeutic strategy for many patients with congenital heart diseases. The aim of this study was to evaluate the role of therapeutic cardiac catheterization in the treatment of complex congenital heart diseases.
Balloon atrial septostomy (BAS) was performed in 59 children using Rashkind balloon catheter. Static balloon dilatation of the atrial septum was performed in 2 children with hypoplastic right heart syndrome. One child with pulmonary artery stenosis at the suture lines after arterial switch was treated with balloon dilatation. Percutaneous balloon pulmonary valvuloplasty (PBPV) and balloon angioplasty were performed in 15 children with tetralogy of Fallot (TOF). Transcatheter coil embolization was performed in 18 children with systemic to pulmonary collateral vessels and 5 children with B-T shunts before surgical procedures. Transcatheter closure of fenestration with Amplatzer septal occluder device was performed in 1 child who had undergone Fontan procedure.
In 46 children with transposition of great arteries (TGA), the arterial oxygen saturation (SaO(2)) was increased from 0.57 +/- 0.17 to 0.76 +/- 0.13 (t = 14.58, P < 0.01) after BAS. The pressure gradients across left and right atrium were less than 2 mmHg. The created atrial septal defects were 5 - 20 mm in size. In 10 children with pulmonary atresia with intact ventricular septum (PA/IVS), the arterial oxygen saturation did not change after BAS (t = 1.57, P > 0.05), but the pressure gradients across left and right atrium were less than 2 mmHg. In children with TOF, the arterial oxygen saturation was increased by 15 percent after PBPV and pulmonary valvular stenosis was relieved. In 14 of 18 children with systemic to pulmonary collateral vessels and 5 children with B-T shunts, complete occlusion was accomplished and the procedures were successful. In the child who had undergone Fontan procedure, the fenestration was occluded successfully and no complication was observed.
In management of complex congenital heart diseases, combination of surgical procedure and interventional catheterization therapy could be suggested to have better outcome.
心脏介入导管技术的进展改变了许多先天性心脏病患者的治疗策略。本研究旨在评估治疗性心脏导管技术在复杂先天性心脏病治疗中的作用。
使用拉什金德球囊导管对59例儿童进行球囊房间隔造口术（BAS）。对2例右心发育不良综合征患儿进行房间隔静态球囊扩张术。对1例动脉调转术后肺动脉吻合口狭窄的患儿进行球囊扩张术。对15例法洛四联症（TOF）患儿进行经皮球囊肺动脉瓣成形术（PBPV）和球囊血管成形术。对18例体肺分流患儿和5例B-T分流患儿在手术前进行经导管弹簧圈栓塞术。对1例接受Fontan手术的患儿使用Amplatzer房间隔封堵器进行经导管开窗封堵术。
在46例大动脉转位（TGA）患儿中，BAS术后动脉血氧饱和度（SaO₂）从0.57±0.17提高到0.76±0.13（t = 14.58，P < 0.01）。左右心房之间的压力阶差小于2 mmHg。所形成的房间隔缺损大小为5 - 20 mm。在10例室间隔完整的肺动脉闭锁（PA/IVS）患儿中，BAS术后动脉血氧饱和度未改变（t = 1.57，P > 0.05），但左右心房之间的压力阶差小于2 mmHg。在TOF患儿中，PBPV术后动脉血氧饱和度提高了15%，肺动脉瓣狭窄得到缓解。在18例体肺分流患儿中的14例和5例B-T分流患儿中，实现了完全封堵，手术成功。在接受Fontan手术的患儿中，开窗成功封堵，未观察到并发症。
在复杂先天性心脏病的治疗中，建议手术与介入导管治疗相结合可取得更好的疗效。
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