经皮介入栓堵双向Glenn术后扩张的奇静脉

目的:总结经皮介入栓堵双向Glenn术后扩张奇静脉的结果。方法:8例复杂性先天性心脏病患儿,双向Glenn术后发现奇静脉和/或半奇静脉扩张,平均年龄(7.7±3.3)岁,平均体质量(24±6)kg,距双向Glenn手术1.0～4.7年,平均2.7年。入院时氧饱和度(SO2)平均(0.80±0.08)。心血管造影显示扩张的奇静脉和/或半奇静脉,平均内径(8±2)mm,与上腔静脉内径比值平均0.66±0.14。肺动脉的Mcgoon比值平均2.3±0.3,Nakata指数平均(248±75)mm2/m2,平均肺动脉压(PAP)和上腔静脉压(SCVP)均为(13.4±3.3)mmHg(1 mmHg=0.133 kPa)。1例合并左肺动脉(LPA)起始部中度狭窄。于基础麻醉下经皮导管栓堵奇和/或半奇静脉,1例同时行LPA狭窄部位球囊扩张。结果:栓堵术后SO2升高至平均〔(0.86±0.04),P<0.0001〕,PAP〔(12.9±3.4)mmHg,P=0.53〕和SVCP〔(12.7±3.2)mmHg,P=0.09〕无变化。4例于栓堵术后1 w至1年行全腔静脉-肺动脉连接术(TCPC)。4例随诊1～2年SO2无变化。结论:双向Glenn术后合并奇静脉和/或半奇静脉扩张、SO2降低,但无SCVP或PAP升高者,可经皮介入栓堵奇静脉和/或半奇静脉,以增加肺血流量,提高体循环SO2。

Percutaneous occlusion of the dilated azygous vein after bidirectional Glenn shunt

Objective:To summarize the results of percutaneous occlusion of the dilated azygous vein after bidirectional Glenn operation.Methods: 8 patients aged(7.7±3.4) years were found dilated azygous or /and hemiazygous veins(2.7 years,1.0-4.7 years)after bidirectional Glenn shunt.Their oxygen saturation(SO2) were((80±8) %,68%-92%).Cardiac catheterization revealed the diameter of the dilated azygous or hemiazygous veins were((8±2) mm,6-11mm),the ration of to that of the super cava vein(SVC) were((0.66±0.14),0.48-0.84).The Mcgoon and the Nakata index of pulmonary arteries were((2.3±0.3),2.0-2.9)and((248±75) mm2/m2,118-305 mm2/m2).The mean pulmonary pressure(PAP) and SVC pressure(SVCP) were both(13.4±3.3) mmHg(1 mmHg=0.133 kPa).Moderated stenosis was found at the origin of the left pulmonary artery(LPA)in one patient.Results: The azygous or /and hemiazygous vein were successfully occluded percutaneously with coils in 5 cases,with duct occluders in 3 patients under general anesthesia.The stenosed LPA were dilated with balloon simultaneously.SO2 rose to((86±4.3)%,P<0.0001)immediately after the occlusions.But the PAP((12.9±3.4) mmHg,P=0.53)and SVCP((12.7±3.2) mmHg,P=0.09)were not changed.4 of the 8 cases were received Fontan procedures uneventfully one week to one year after the occlusions.2 cases waiting for Fontan operation,and 2 cases not suitable for Fontan were both followed up for 1 to 2 years,with SO2 not changed.Conclusions: Dilated azygous or /and hemiazygous veins in patients after bidirectional Glenn without SCVP or PAP hypertension,can be transcatheterly closured with coils or duct occluders,resulting in increased pulmonary blood supply and SO2.