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儿童复杂性先天性心脏病同期介入治疗的临床分析与中期随访:一项单中心回顾性研究

Clinical analysis and medium-term follow-up of simultaneous interventional therapy for compound congenital heart disease in children: a single-center retrospective study.

作者信息

Ran Tingting, Feng Lingxin, Li Mi, Yi Qijian, Zhu Xu, Ji Xiaojuan

机构信息

Department of Ultrasound, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.

Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.

出版信息

Front Pediatr. 2023 Jun 22;11:1193136. doi: 10.3389/fped.2023.1193136. eCollection 2023.

Abstract

OBJECTIVE

This study aimed to explore the safety and efficacy of simultaneous interventional therapy for compound congenital heart disease (CCHD) in children.

METHODS

In total, 155 children with CCHD who received simultaneous interventional therapy at the Children's Hospital of Chongqing Medical University between January 2007 and December 2021 were included in study. Data on clinical manifestations, transthoracic echocardiography, electrocardiogram, and follow-up were retrospectively analyzed.

RESULTS

The most common type of CCHD was atrial septal defect (ASD) combined with ventricular septal defect (VSD), accounting for 32.3% of the patients. Simultaneous interventional therapy was successfully administered to 151 children (97.4%). The pulmonary gradient of patients with pulmonary stenosis decreased from 47.3 ± 21.9 mmHg to 15.2 ± 12.2 mmHg (< 0.05) immediately after the procedure. One patient had failed PBPV as he had residual PS >40 mmHg post procedure. The right ventricular dimension and left ventricular end-diastolic dimension significantly decreased in the first month after the procedure in patients with ASD combined with VSD. Twenty-five (16.1%) patients had mild residual shunt, which spontaneously disappeared in more than half of these patients 6 months after the procedure. The major adverse events were minimal ( = 4, 2.58%), including one patient requiring drug treatment for complete atrioventricular block and three patients receiving surgical treatment because of cardiac erosion, anterior tricuspid valve chordae rupture, and hemolysis, respectively.

CONCLUSIONS

ASD combined with VSD is the most common type of CCHD in children, and simultaneous interventional therapy for CCHD in children is safe and effective with satisfactory results. Ventricular remodeling can be reversed in patients with ASD combined with VSD 1 month after the procedure. Most adverse events associated with interventional therapy are mild and manageable.

摘要

目的

本研究旨在探讨儿童复合先天性心脏病(CCHD)同期介入治疗的安全性和有效性。

方法

纳入2007年1月至2021年12月在重庆医科大学附属儿童医院接受同期介入治疗的155例CCHD患儿。对临床表现、经胸超声心动图、心电图及随访资料进行回顾性分析。

结果

CCHD最常见类型为房间隔缺损(ASD)合并室间隔缺损(VSD),占患者的32.3%。151例患儿(97.4%)成功接受同期介入治疗。肺动脉狭窄患者术后即刻肺动脉压差从47.3±21.9 mmHg降至15.2±12.2 mmHg(<0.05)。1例患者经皮球囊肺动脉瓣成形术(PBPV)失败,术后残余肺动脉狭窄>40 mmHg。ASD合并VSD患者术后第1个月右心室大小和左心室舒张末期内径显著减小。25例(16.1%)患者有轻度残余分流,其中半数以上患者术后6个月残余分流自发消失。主要不良事件极少(n = 4,2.58%),包括1例因完全性房室传导阻滞需药物治疗,3例分别因心脏穿孔、三尖瓣前叶腱索断裂和溶血接受手术治疗。

结论

ASD合并VSD是儿童CCHD最常见类型,儿童CCHD同期介入治疗安全有效,效果满意。ASD合并VSD患者术后1个月心室重构可逆转。大多数与介入治疗相关的不良事件较轻且可控。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/64ae/10325865/cf0256b1ca4f/fped-11-1193136-g001.jpg

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