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[儿童先天性心脏病合并症的经导管治疗]

[Transcatheter therapy of combined congenital heart diseases in children].

作者信息

Zhang Yi-ying, Zhu Wei-hua, Xia Cheng-sen, Gong Fang-qi, Xie Chun-hong, Huang Xian-mei, Kang Man-li

机构信息

The Affiliated Children's Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.

出版信息

Zhejiang Da Xue Xue Bao Yi Xue Ban. 2006 May;35(3):327-30. doi: 10.3785/j.issn.1008-9292.2006.03.018.

Abstract

OBJECTIVE

To investigate the methods of interventional catheterization for combined congenital heart disease and to evaluate its efficacy in children.

METHODS

From March 1994 to December 2003, 15 cases (6 boys, 9 girls) underwent transcatheter intervention for combined congenital heart diseases. The procedure of transcatheter intervention was as follows: for pulmonary stenosis (PS) and atrial septal defect (ASD) or patent ductus arteriosus (PDA), PBPV first, occlusion of ASD or PDA later; for coarctation of aorta (COA) and PDA, dilation of COA first, occlusion of PDA 4-15 months later; for aortic stenosis (AS) and PDA, PBAV first, occlusion of PDA later; for ventricular septal defect (VSD) and PDA, all occlusions with detachable coils.

RESULT

Transcatheter intervention for combined congenital heart diseases was successful in all patients. There was no residual shunt after occlusion immediately apart from 2 cases of PDA which were little residual after occlusion immediately. Follow-up for (3.57 +/-2.61) years, the systolic pressure gradients across pulmonary valve and coarctation were normal by ultrasonic or transcatheter, except AS. There was 3 cases presented postoperative complications: 1 with mechanical haemolysis, 1 with fall off of coil and 1 with arterial embolism, respectively.

CONCLUSION

Transcatheter intervention for combined congenital heart diseases could obtain satisfactory results with appropriate indications and procedure manipulations.

摘要

目的

探讨先天性心脏病合并畸形的介入导管治疗方法,并评价其在儿童患者中的疗效。

方法

1994年3月至2003年12月,15例先天性心脏病合并畸形患者(男6例,女9例)接受了经导管介入治疗。经导管介入治疗步骤如下:对于肺动脉狭窄(PS)合并房间隔缺损(ASD)或动脉导管未闭(PDA),先进行经皮球囊肺动脉瓣成形术(PBPV),随后封堵ASD或PDA;对于主动脉缩窄(COA)合并PDA,先扩张COA,4~15个月后封堵PDA;对于主动脉瓣狭窄(AS)合并PDA,先进行经皮球囊主动脉瓣成形术(PBAV),随后封堵PDA;对于室间隔缺损(VSD)合并PDA,均采用可脱性弹簧圈封堵。

结果

所有患者经导管介入治疗均成功。除2例PDA封堵后有少量残余分流外,其余封堵后均无残余分流。随访(3.57±2.61)年,除AS外,经超声心动图或心导管检查,肺动脉瓣及主动脉缩窄处收缩期压力阶差均正常。术后出现3例并发症:分别为1例机械性溶血、1例弹簧圈脱落和1例动脉栓塞。

结论

先天性心脏病合并畸形经导管介入治疗,只要适应证选择恰当,操作方法正确,可以取得满意的效果。

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