Zeevi B, Perry S B, Keane J F, Mandell V S, Lock J E
Department of Cardiology, Children's Hospital, Boston, Massachusetts.
Clin Perinatol. 1988 Sep;15(3):633-58.
The currently available interventional cardiac procedures in neonates and infants are at various stages of development. We currently dilate neonates and infants with critical valvular pulmonary and aortic stenosis and postoperative aortic obstruction. We do not routinely dilate native coarctation of the aorta because of the possibility of aneurysm formation, unless the neonate is very sick and acidotic and an operative approach is considered to be high risk. Balloon and blade atrial septostomy are done routinely whenever indicated with a low incidence of morbidity. Coil embolization, endomyocardial biopsy, foreign body retrieval and percutaneous pericardial drainage are relatively safe, and with the currently available instruments these techniques can be performed safely in neonates and infants with the same indications as for older patients. We currently consider stenotic pulmonary veins to be an undilatable lesion and an optimal therapy remains to be defined. Transcatheter closure of PDA and intracardiac shunts is presently limited to older patients, due to the large size of the delivery system devices and cannot currently be used in neonates. Dilation of the pulmonary valve in cyanotic congenital heart disease appears useful, but further experience is needed.
目前用于新生儿和婴儿的介入性心脏手术正处于不同的发展阶段。我们目前对患有严重瓣膜性肺动脉和主动脉狭窄以及术后主动脉梗阻的新生儿和婴儿进行扩张治疗。我们通常不常规扩张先天性主动脉缩窄，因为存在形成动脉瘤的可能性，除非新生儿病情非常严重且酸中毒，并且手术方法被认为风险很高。只要有指征，就会常规进行球囊和刀片房间隔造口术，发病率较低。弹簧圈栓塞、心内膜活检、异物取出和经皮心包引流相对安全，使用目前可用的器械，这些技术可以在具有与年长患者相同指征的新生儿和婴儿中安全地进行。我们目前认为狭窄的肺静脉是不可扩张的病变，最佳治疗方法仍有待确定。由于输送系统装置尺寸较大，目前经导管闭合动脉导管未闭和心内分流仅限于年长患者，目前不能用于新生儿。在青紫型先天性心脏病中扩张肺动脉瓣似乎是有用的，但还需要更多经验。
