经胸超声心动图在先天性心脏病介入封堵术中的应用

目的观察经胸超声心动图（TTE）在先天性心脏病（先心病）介入封堵术中的应用。方法采用TTE观察97例房间隔缺损（ASD）、84例室间隔缺损（VSD）及75例动脉导管未闭（PDA）经介入封堵治疗的先心病患者，在介入封堵术前选择病例、术中引导和监测封堵器释放全过程及术后随访。结果256例先心病患者除5例ASD外其余均封堵成功，术后1周～6月超声随访无一例出现并发症。结论TTE在先心病介入封堵术中具有重要价值。     

先天性心脏病介入治疗后的抗栓治疗策略

<正>目前,我国先天性心脏病(先心病)的发病率为7‰~8‰,新生儿每年患病约有12万~15万~[1]。过去开胸手术是治疗该病的唯一方法,随着介入治疗学科的发展,该技术在临床中逐渐普及,成为不同种类先心病的常用治疗方式。目前先心病介入治疗的主要手术有房间隔缺损封堵术、卵圆孔未闭封堵术、室间隔缺损封堵术以及动脉导管未闭封堵术,总体临床效果较满意。术后血栓形成发生率不高,但有     

先天性心脏病介入封堵治疗严重并发症的发生和防治

目的分析先天性心脏病(先心病)介入封堵治疗中和治疗后严重并发症的发生率、原因及防治措施。方法对179例3种常见先心病施行了介入封堵治疗,其中动脉导管未闭(PDA)封堵术82例(PDO组);房间隔缺损(ASD)封堵术56例(ASO组);室间隔缺损(VSD)封堵术51例(VSO组)。对介入治疗中和治疗后发生的10例严重并发症作回顾性分析。结果严重并发症总发生率为5.59%(10/179),其中PDO为2.44%(2/82);ASO组为10.71%(6/56);VSO组为3.92%(2/51)。紧急手术率为1.12%(2/179)。结论先心病介入封堵术是一种微创而有效治疗措施,但其并发症不容忽视,尤以ASD封堵术发生率最高。     

先天性心脏病介入封堵未成功原因分析

目的：分析先天性心脏病（先心病）介入封堵治疗未成功原因及防治措施。方法：对206例3种常见先心病施行了介入封堵治疗．其中动脉导管未闭（PDA）封堵64例（PDA组）;房间隔缺损（ASD）封堵76例（ASD组）;室间隔缺损（VSD）封堵66例（VSD组）。对介入治疗未成功的7例作了回顾分析。结果：未成功率为3．40％（7／206）。其中PDA组为3．13％（2／64）,ASD组为2．63％（2／76）,VSD组为4．55％（3／66）。未成功原因是：对导管大小判断有误,放置封堵伞有误,输送鞘管引起迷走神经反射。结论：先心病介入封堵术是一种微创、有效的治疗措施,但影响手术成功的因素不容忽视。     

先天性心脏病介入治疗严重并发症的分析及处理

目的:探讨先天性心脏病(先心病)介入治疗中和治疗后严重并发症的发生率、原因及防治措施。方法:自2004年1月至2014年9月,我院共有507例先心病患者施行介入治疗。将其中发生的需经急诊介入或外科手术处理的并发症定义为严重并发症。结果:507例先心病患者中发生封堵伞脱落5例。介入术中及术后严重并发症封堵伞脱落总发生率为1.0%(5/507),其中房间隔缺损(ASD)组的并发症为封堵伞脱落4例,0.1%(4/276);主动脉窦瘤破裂封堵术组,封堵伞脱落1例:为33.3%(1/3)。紧急开胸手术占1.0%(5/507)。结论:先心病介入治疗的严重并发症发生率低,但应警惕封堵伞脱落,一经确诊,需积极外科手术治疗。     

成人先天性心脏病介入封堵术前后炎症细胞因子的变化

目的:观察成人先天性心脏病(简称先心病)介入封堵术前后炎症细胞因子的变化,探讨介入封堵术对成人先心病免疫激活状况的影响.方法:选择55例成人先心病患者(先心病组),其中40例行介入封堵术;30例年龄及性别与之相匹配的正常体检成人作为对照组.用酶联免疫吸附法(ELISA),检测对照组及先心病组介入封堵术前和术后3、6个月血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及IL-10的动态变化.结果:先心病组术前血清TNF-a、IL-6及IL-10显著高于对照组(均P＜0.01),TNF-α/IL-10升高更明显(P＜0.01);先心病随着心功能级别增高,血清TNF-α及IL-6水平明显增高(均P＜0.05),IL-10水平明显降低(P＜0.05);介入封堵术后3个月血清所测细胞因子均明显降低(均P＜0.01),至6个月恢复至正常水平.结论:成人先心病存在着一定程度的免疫激活.致使炎性细胞因子增加和抗炎性细胞因子相对不足,并与疾病的严重性关系密切.介入封堵术后免疫系统逐渐恢复平衡.     

先天性心脏病患儿介入治疗的辐射剂量

目的建立常见先天性心脏病(先心病)介入手术的单中心辐射剂量值,以加强国内先心病介入医师的术中辐射防护意识。方法回顾性收集复旦大学附属儿科医院2016年1月至2018年10月采用低辐射剂量影像策略下进行的先心病介入手术的辐射剂量值,包括透视时间、空气比释动能和剂量-面积乘积(DAP)。纳入先心病介入手术种类包括动脉导管未闭封堵术、房间隔缺损封堵术、室间隔缺损封堵术、肺动脉瓣狭窄成形术、主动脉缩窄球囊血管成形术和复杂体-肺动脉侧支堵闭术。结果纳入496例先心病患儿介入手术中,动脉导管未闭封堵术、房间隔缺损封堵术、室间隔缺损封堵术、肺动脉瓣狭窄成形术、主动脉缩窄球囊血管成形术和复杂体-肺动脉侧支堵闭术分别为178例、77例、96例、68例、36例和41例,介入手术的辐射剂量DAP/kg中位数分别为7.25μGy·m2/kg、8.99μGy·m2/kg、24.61μGy·m2/kg、12.61μGy·m2/kg、11.68μGy·m2/kg和30.74μGy·m2/kg。结论本研究建立了低辐射剂量影像策略下六类常见先心病患儿介入手术的单中心辐射剂量值,可用于儿童先心病介入手术辐射防护质量的初步评价。     

经皮介入封堵室间隔缺损与传导系统的损伤

无论是经皮介入封堵还是经外科手术修补治疗先天性心脏病(先心病)室间隔缺损(VSD),房室传导阻滞(AVB)都是最为严重的并发症之一.近年随着经皮介入封堵VSD技术的迅速普及,这一并发症的报道日益增多,并已经备受人们关注.近期国内外陆续有大样本经皮介入封堵治疗的临床报告.本文拟结合近期文献对该手术和传导系统损伤的关系作一综述分析.     

先天性心脏病介入治疗17例并发症的原因及处理

目的 分析先天性心脏病(先心病)介入封堵治疗中和治疗后并发症的发生率、原因及防治措施.方法 自2008年3月至2012年3月,上海远大心胸医院共有1077例先心病患者进行了介入治疗,对介入治疗中和治疗后发生的17例并发症患者作回顾性分析.结果 1077例先心病患者介入术中及术后并发症总发生率为1.58％ (17/1077),无死亡病例.房间隔缺损(ASD)组共3例出现并发症,占了ASD组的0.99％( 3/303);动脉导管未闭(PDA)组共3例出现并发症占了PDA组的0.97％ (3/310);室间隔缺损组(VSD)组共11例出现并发症,占了VSD组的2.61％( 11/421),肺动脉瓣球囊成形术( PBPV)组未见并发症,并发症均经保守治疗或介入处理.结论 先心病介入封堵术是一种微创而有效的治疗措施,但其并发症不容忽视,尤以VSD封堵术发生率最高.先心病介入治疗的并发症及病死率低,术前应进行充分沟通,术后应作严格随访,尤其警惕部分介入治疗术后迟发并发症的发生.     

封堵器介入治疗先天性心脏病的护理

随着介入心脏病学的发展，经导管介入封堵术治疗先心病已被广泛的应用于临床。先天性心脏病以动脉导管未闭，房间隔缺损，室间隔缺损最为多见，以前大多采用外科手术治疗，现在由于介入治疗术创伤小，痛苦少，术后恢复快，住院时间短，疗效可靠等诸多优点，深受患者及家属的认可。先天性心脏病封堵器介入治疗的疗效非常关键，但是介入治疗后的护理也不容忽视，现将先心病患者经导管封堵术的护理体会报告如下。     

延迟关胸技术在小儿开胸心脏术后的应用

目的介绍延迟关胸技术在先天性心脏病手术中的应用。方法研究阜外医院心外科2001年1月～2002年12月期间小儿开胸心脏手术的临床资料,其中有8例成功延迟关胸,并痊愈出院。结果延迟关胸的原因1例为出血,其他7例为血液动力学不稳定。胸骨敞开时间平均为3.1d(2～5d)。延迟关胸后,血管活性药物剂量明显下降,血液动力学稳定,其中平均动脉压上升15.4mmHg(1～24.6mmHg)。结论对于小儿开胸心脏手术后出现的血液动力学不稳定、低心排、出血,延迟关胸是一种安全而有效的解决方法。     

Applications of three-dimensional transesophageal echocardiography in congenital heart disease

Three-dimensional echocardiography allows for presurgical planning for congenital heart disease, reduces radiation using fusion imaging in catheter interventions, and provides guidance during catheter interventions and lead placements or extractions. The purpose of this review is to detail applications of three-dimensional transesophageal echocardiography in presurgical planning of congenital heart disease, guidance of catheter interventions such as fusion imaging, and guidance in electrophysiology lead extractions or placements.     

纽扣式补片术治疗成人先天性心脏病113例

目的 :评价纽扣式补片术治疗成人先天性心脏病的疗效及总结其经验。方法 :采用经导管纽扣式补片治疗先天性心脏病 113例 ,其中房间隔缺损 (ASD) 45例 ,动脉导管未闭 (PDA) 45例 ,室间隔缺损 (VSD) 2 3例。结果 :ASD、PDA、VSD成功率分别为 10 0 % (4 5/45例 )、95.6 % (4 3/45例 )和 83.0 % (19/2 3例 ) ,总成功率为 94 .6 %。手术并发症主要见于 VSD患者 ,束支传导阻滞发生率为 2 6 .4 3% (6 /2 3例 )。结论 :纽扣式补片术治疗成人先天性心脏病成功率高 ,即时疗效显著 ,并发症少 ,是一种安全的介入治疗方法     

先天性心脏病介入封堵术后心功能、NT-proBNP及CRP水平的变化

目的探讨心功能、N端前脑钠素（NT—proBNP）及C-反应蛋白（CRP）水平在衡量先天性心脏病患者介入封堵术后远期效果中的意义。方法所有患者分别于术前，术后1个月、3个月测定心功能、血清NT—proBNP及CRP水平。结果先天性心脏病介入封堵术后1个月、3个月心功能较术前明显改善（P〈0．01），血清NT—proBNP及CRP水平较术前明显降低（P〈0．01）。结论心功能、NT—proBNP及CRP水平在衡量先天性心脏病介入封堵术后远期效果方面具有重要价值，但尚需大规模长期随访观察。     

Irrigated-tip catheter ablation of intraatrial reentrant tachycardia in patients late after surgery of congenital heart disease

OBJECTIVES: The aim of this study was to evaluate irrigated-tip catheter for ablation of intraatrial reentrant tachycardias late after surgical repair of congenital heart disease. BACKGROUND: In congenital heart disease patients, the right atrium can be markedly enlarged with areas of low blood flow. Radiofrequency (RF) lesion creation may be hampered by insufficient electrode cooling at sites with low blood flow. METHODS: Thirty-six consecutive patients with intraatrial reentrant tachycardia refractory to antiarrhythmic therapy from two centers were included in the study. Entrainment pacing and electroanatomic mapping (CARTO) were used to delineate reentrant circuits and critical isthmus sites. RF ablation was performed using an irrigated-tip catheter (Navistar Thermocool). RESULTS: Fifty-two intraatrial reentrant tachycardia circuits were identified, and 48 were targeted with RF ablation. RF ablation was performed using a mean of 13 +/- 11 irrigated RF applications per tachycardia isthmus with a mean power of 36 +/- 8 W. In a historical control group of congenital heart disease patients managed with conventional catheter ablation, the number of lesions per isthmus was higher (23 +/- 11) and mean power was lower (27 +/- 14 W). Acute success was achieved in 45 intraatrial reentrant tachycardias (94% of targeted tachycardias and 87% of all tachycardias). After a mean follow-up of 17 +/- 7 months, 33 (92%) of 36 patients were free of recurrence. Five patients (14%) developed paroxysmal atrial fibrillation. CONCLUSIONS: The combination of modern techniques including electroanatomic mapping and catheter irrigation allows safe and highly effective ablation of intraatrial reentrant tachycardia in patients with surgically repaired congenital heart disease.     

Cardiac Catheterization and Selective Angiography in Infants with a New Flow-Directed Catheter

Preliminary experience with a new flow-directed pediatric anglography catheter in 35 infants indicates that catheterization of all cardiac chambers and both great vessels can be accomplished without risk of perforation or major arrhythmia. Antegrade access to the aorta from the left ventricle via the foramen ovale reduced the need for retrograde arterial catheterization. The maneuverability of this balloon-tipped catheter coupled with the ability to perform safely selective anglography at any site entered establishes a unique advantage over standard cardiac catheters now in use. The success with this catheter in performing right and left heart studies and the safety in its use promise to significantly reduce the risk of mechanical and angiographic accidents during the intracardiac investigation of critically ill Infants with congenital heart disease.     

Interventional fellowship in structural and congenital heart disease for adults

Training for structural and adult congenital heart disease interventions remains undeveloped. With the advent of recent percutaneous interventions for the treatment of structural and valvular heart disease, such as transcatheter aortic and pulmonary valve implantation, mitral valve repair, and the expansion of shunt closure procedures, there is a clear need to define the training requirements for this category of procedures. The training needs to be aligned with the goals and priorities of a basic or advanced level and be categorized into acquired and congenital. This document will define the training needs and knowledge base for the developing field of structural heart disease intervention. © 2010 Wiley‐Liss, Inc.     

介入治疗先天性心脏病118例近期疗效评价

目的：评价应用国产封堵器治疗动脉导管未闭（PDA）、房间隔缺损（ASD）室间隔缺损（VSD）的近期疗效及安全性。方法：118例先天性心脏病患者（PDA24例，ASD48例，VSD46例）均在X线透视及经胸超声心动图监视下经导管置入封堵器治疗PDA、ASD和VSD。结果：全组封堵成功率98．3％，所有封堵成功的患者均于术后24h、7d、1月和3月行经胸超声心动图检查，均无残余分流。结论：经导管置入封堵器是治疗PDA、ASD和VSD的一种操作简便、成功率高、疗效可靠的介入方法。     

应用超声心动图大规模筛查儿童先天性心脏病

第6届中13德三国联合国际心血管病学术研讨会——心血管病,心脏内外、科进展,于2010年6月26～27日在天津泰达国际心血管病医院召开。这次会议由中、日、德三国心血管内外科、麻醉科、体外循环、心血管诊断影像学数十位专家做了有关专业领域内最新进展的专题报告,涵盖冠心病、心脏瓣膜疾病、先天性心脏病、心脏移植及辅助装置、心律失常、心衰治疗,以及心血管外科手术、麻醉及体外循环等多个领域。这次刊出会议论文摘要选编精华,以帮助心血管专业同道了解相关领域的重要进展。会议发言全部采用英文。为使读者更清晰地了解发言内容,我们对部分讲座由主讲人提供了中文摘要,现同时发表,以飨读者。     

MRI‐guided congenital cardiac catheterization and intervention: The future?

Over the last 10 years, a number of technological advances have allowed real-time magnetic resonance imaging to guide cardiac catheterization, including improved image quality, faster scanning times, and open magnets allowing access to the patient. Potential advantages include better soft tissue imaging to improve catheter manipulation and additional functional information to assist with interventional decision-making, all without exposure to ionizing radiation. MRI-guided diagnostic catheterization, balloon dilation, stent placement, valvar replacement, atrial septal defect closure, and radiofrequency ablation all have been shown feasible in animal models. MRI-guided catheterization has the potential to replace the current X-ray-based diagnostic and interventional procedures for children with congenital heart disease, avoiding all radiation exposure while improving soft tissue imaging.