Perry S B, Keane J F, Lock J E
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Am J Cardiol. 1988 May 9;61(14):109G-117G. doi: 10.1016/s0002-9149(88)80042-0.
The present status of catheter-directed therapy in pediatric congenital and acquired heart disease is reviewed. Balloon pulmonary valvotomy, established as the procedure of choice for children and adults with isolated pulmonary stenosis, has now been extended to neonates with critical pulmonary stenosis. Balloon mitral and aortic valvotomy are being performed for congenital and acquired stenoses, although indications and optimal techniques remain to be established. Balloon angioplasty of coarctation effectively relieves obstruction in native and post-operative aortic arch stenoses, but remains controversial due to late aneurysm formation. Balloon angioplasty of branch pulmonary artery hypoplasia and stenosis, despite a relatively low success rate and significant complications, remains the procedure of choice due to lack of better therapeutic options. Transcatheter closure of congenital and acquired vessels and defects is being performed with increasing frequency. Embolization of aortopulmonary collaterals and shunts using Gianturco coils is safe and effective in selected patients. Although Rash-kind umbrellas are most commonly used for closure of a patent ductus arteriosus, their use, especially in closing intracardiac defects, remains investigational.
本文综述了导管介入治疗在小儿先天性和后天性心脏病中的现状。球囊肺动脉瓣切开术已成为孤立性肺动脉狭窄患儿和成人的首选治疗方法，目前已扩展至患有严重肺动脉狭窄的新生儿。球囊二尖瓣和主动脉瓣切开术正在用于先天性和后天性狭窄的治疗，尽管其适应症和最佳技术仍有待确定。动脉导管未闭球囊血管成形术可有效缓解原发性和术后主动脉弓狭窄，但由于晚期动脉瘤形成，仍存在争议。分支肺动脉发育不全和狭窄的球囊血管成形术尽管成功率相对较低且并发症严重，但由于缺乏更好的治疗选择，仍然是首选方法。先天性和后天性血管及缺损的经导管封堵术的应用频率越来越高。使用弹簧圈栓塞主肺动脉侧支血管和分流在特定患者中是安全有效的。虽然Rash-kind伞最常用于动脉导管未闭的封堵，但它们的应用，尤其是用于封堵心内缺损，仍处于研究阶段。
