Lu Guo-Liang, Sun Ting, Huang Jie-Zhou, Xie Shao-Bo
Department of Cardiovascular Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Ultrasonography, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Transl Pediatr. 2021 Jan;10(1):112-120. doi: 10.21037/tp-20-202.
Transthoracic intervention for isolated congenital heart disease (CHD) has been well tested for its technological feasibility and is increasingly used in clinical practice. We aimed to present our experience in simultaneous transthoracic intervention for multiple cardiac lesions in a series of pediatric patients.
Between March 2015 and December 2019, 20 patients with multiple CHD were referred to this study; mean age was 18.8±8.6 (range, 4-36) months. The transthoracic echocardiography (TTE) diagnosis was atrial septal defect (ASD) and perimembranous ventricular septal defect (pmVSD) in 7 patients, patent ductus arteriosus (PDA) and ASD in 6, pmVSD and PDA in 2, pmVSD and valvular pulmonary stenosis (PS) in 2, ASD and PS in 2, and doubly committed subarterial VSD (dcsVSD) and PS in 1 patient. These patients underwent simultaneous transthoracic interventions with transesophageal echocardiography guidance. The procedure sequence was PS→VSD→PDA→ASD. Electrocardiography and TTE were scheduled at discharge and follow-ups.
All patients were occluded successfully without any thoracotomy conversion. Operation time was 56-120 (mean, 75±13) minutes. A 1.5-2.0-cm median sternum incision was performed in 6 ASD&PDAs, 2 ASD&PSs, and 1 dcsVSD&PS. In 11 other patients, a 1.5-2.0-cm incision in the inferior sternum was made and the chest closed with a drain. There were no serious complications before discharge and at follow-up.
Simultaneous transthoracic intervention for multiple cardiac defects in children is feasible with good short-term outcomes. For different lesions, the appropriate surgical incision and operational sequence can render the intervention minimally invasive and safer.
经胸介入治疗孤立性先天性心脏病（CHD）的技术可行性已得到充分验证，并在临床实践中越来越多地应用。我们旨在介绍我们在一系列儿科患者中同时经胸介入治疗多种心脏病变的经验。
2015年3月至2019年12月，20例患有多种CHD的患者被纳入本研究；平均年龄为18.8±8.6（范围4 - 36）个月。经胸超声心动图（TTE）诊断为7例房间隔缺损（ASD）合并膜周部室间隔缺损（pmVSD），6例动脉导管未闭（PDA）合并ASD，2例pmVSD合并PDA，2例pmVSD合并瓣膜性肺动脉狭窄（PS），2例ASD合并PS，1例双动脉下室间隔缺损（dcsVSD）合并PS。这些患者在经食管超声心动图引导下接受了同时经胸介入治疗。手术顺序为PS→VSD→PDA→ASD。出院时及随访时安排心电图和TTE检查。
所有患者均成功封堵，无一例转为开胸手术。手术时间为56 - 120（平均75±13）分钟。6例ASD&PDA、2例ASD&PS和1例dcsVSD&PS患者采用1.5 - 2.0 cm的正中胸骨切口。其他11例患者在胸骨下段做1.5 - 2.0 cm切口，置引流管后关闭胸腔。出院时及随访时均无严重并发症。
儿童同时经胸介入治疗多种心脏缺损是可行的，短期效果良好。对于不同病变，合适的手术切口和操作顺序可使介入治疗微创且更安全。
