肺动脉瓣狭窄合并房间隔缺损的介入治疗效果分析

目的 探讨儿童先天性肺动脉瓣狭窄合并房间隔缺损的介入治疗方法和临床随访效果.方法 27例肺动脉瓣狭窄合并房间隔缺损的患儿,同时进行肺动脉瓣成形术和房间隔缺损封堵术,术后即刻、1周、3个月、6个月行超声心动图检查,随访其临床效果.结果 27例经皮球囊肺动脉瓣成形术均获得成功,术后即刻测量跨肺动脉瓣压力阶差由术前的(79±62)mmHg降至(49±36)mmHg,术后超声心动图随访过程中跨肺动脉瓣压力阶差持续下降.超声心动图测量房间隔缺损直径为3.4～24.6(11.7±6.9)mm,选择封堵器的直径为8～32(14.6±8.7)mm,27例中有24例成功进行封堵.结论 介入治疗肺动脉瓣狭窄并房间隔缺损是一种安全可靠的方法,严格掌握适应让,特别是房间隔缺损的适应证,可取得良好的临床效果.     

介入治疗儿童先天性心脏病586例

目的探讨儿童先天性心脏病(CHD)经皮介入治疗方法及其近期疗效。方法CHD患儿586例。其中单一病变535例,复合病变51例,CHD缺损在经胸彩色超声心动图(TTE)及X线影像指导下,经皮沿导丝经传送鞘管将合适的封堵器至缺损处行封堵。肺动脉瓣狭窄采用Inoue球囊或聚乙烯球囊行肺动脉瓣球囊扩张术。结果TTE测量房间隔缺损(ASD)为(14.8±7.1)mm,所用封堵器为(19.1±8.4)mm;左室造影测量室间隔缺损(VSD)直径为(6.3±2.9)mm,使用封堵器(8.1±3.4)mm;造影测量动脉导管未闭(PDA)最窄处直径为(6.1±2.8)mm,所选用封堵器肺动脉侧为(10.0±3.2)mm,主动脉侧为(12.0±3.2)mm;介入成功561例,25例未封堵成功,成功率95.8%,成功者术后即刻未见明显分流;肺动脉瓣球囊扩张术后患者跨瓣压差均降至20 mm Hg以下。结论儿童CHD经皮介入治疗操作简单、成功率高、安全可靠,近期疗效好。     

房间隔缺损并肺动脉瓣狭窄介入治疗20例临床分析

目的　应用国产双盘状封堵器及国产球囊经导管治疗房间隔缺损 (ASD)并肺动脉瓣狭窄 ,并对其疗效进行初步评价。方法　全组 2 0例 ,年龄 2～ 17岁 ,平均 8.4± 6 .2岁。术前均经超声心动图检测 ,ASD直径为5～ 2 1mm ,平均 14± 6mm ,同时测肺动脉瓣狭窄程度及经超声心动图估测肺动脉压及跨瓣压 ,所有病例均在透视及超声心动图监视下经导管肺动脉瓣球囊扩张术 (PBMV)及置入国产双盘封堵器封堵ASD。全部患儿于术后 4 8h、1～ 3月及 1年分别行超声心动图、心电图、X线胸片检查评价治疗效果。结果　全组技术成功率 10 0 % ,均无重要并发症发生 ,PBMV术后即刻右室收缩压由 84± 2 5mmHg降至 4 0± 10mmHg ,肺动脉至右室跨瓣压由 6 7± 2 6mmHg降至 13.0± 11.5mmHg (P <0 .0 1) ,ASD 1例存在微～少量残余分流 ,19例封堵完全无残余分流。术后2 4h、术后 1月及 1年超声心动图未见残余分流及再通。结论　应用双盘状封堵器及国产球囊经导管治疗房间隔缺损并肺动脉瓣狭窄是一种安全有效的介入方法 ,操作简便 ,成功率高 ,近期疗效可靠 ,中远期疗效尚需进一步观察。     

房间隔缺损并肺动脉瓣狭窄介入治疗20例临床分析

目的　应用国产双盘状封堵器及国产球囊经导管治疗房间隔缺损 (ASD)并肺动脉瓣狭窄 ,并对其疗效进行初步评价。方法　全组 2 0例 ,年龄 2～ 17岁 ,平均 8.4± 6 .2岁。术前均经超声心动图检测 ,ASD直径为5～ 2 1mm ,平均 14± 6mm ,同时测肺动脉瓣狭窄程度及经超声心动图估测肺动脉压及跨瓣压 ,所有病例均在透视及超声心动图监视下经导管肺动脉瓣球囊扩张术 (PBMV)及置入国产双盘封堵器封堵ASD。全部患儿于术后 4 8h、1～ 3月及 1年分别行超声心动图、心电图、X线胸片检查评价治疗效果。结果　全组技术成功率 10 0 % ,均无重要并发症发生 ,PBMV术后即刻右室收缩压由 84± 2 5mmHg降至 4 0± 10mmHg ,肺动脉至右室跨瓣压由 6 7± 2 6mmHg降至 13.0± 11.5mmHg (P <0 .0 1) ,ASD 1例存在微～少量残余分流 ,19例封堵完全无残余分流。术后2 4h、术后 1月及 1年超声心动图未见残余分流及再通。结论　应用双盘状封堵器及国产球囊经导管治疗房间隔缺损并肺动脉瓣狭窄是一种安全有效的介入方法 ,操作简便 ,成功率高 ,近期疗效可靠 ,中远期疗效尚需进一步观察。     

儿童继发孔型房间隔缺损的介入治疗

目的　探讨儿童继发孔型房间隔缺损 (atrialseptaldefect ,ASD)封堵术的指征、方法学和并发症的预防。方法　 1998年 10月～ 2 0 0 3年 1月 ,119例继发孔型ASD患儿 ,根据家属意愿接受了经导管应用Amplatzer房间隔封堵器的介入治疗。年龄 0 8～ 17 0岁 ,平均 ( 7 5± 2 8)岁 ,体重6 7～ 88.0kg ,平均 ( 2 3 7± 7 8)kg。所有病例术前检查被证实均为继发孔型ASD。按ASD球囊伸展直径或大于 1～ 2mm选择封堵器进行堵塞。其中 3例为多发ASD。 6例合并动脉导管未闭 ( patentductusarteriosus,PDA)或肺动脉瓣狭窄 ( pulmonarystenosis ,PS)者应用其他封堵装置和球囊扩张治疗合并的畸形。术后定期行心脏超声及临床检查随访。结果　 119例患儿术前经食道超声(transesophagealechocardiography ,TEE)或经胸超声 (trans thoracicechocardiography ,TTE)检测ASD平均直径 ( 12 9± 5 6 )mm ( 6 5～ 34 5mm ) ,肺动脉平均压力为 ( 2 9 0± 5 0 )mmHg( 2 5 0～ 6 2 0mmHg) ,球囊伸展直径为 ( 15 7± 4 8)mm( 8 0～ 38 0mm)。所选封堵器直径平均为 ( 15 0± 5 0 )mm( 8 0～ 38 0mm)。 112例封堵成功。 3例多发ASD也选用单一封堵器。 6例合并PDA或PS者同时完成介入治疗。 112例堵塞后即刻封堵率为 93 8% ( 1     

法洛三联症的介入治疗及疗效评价

目的探讨儿童法洛三联症的介入治疗方法,并评价其临床疗效。方法法洛三联症患儿16例;年龄3-18岁,平均7.5岁。病例均在X线及超声心动图监视下行经皮肺动脉瓣球囊扩张术(PBPV)及置入国产双盘封堵器封堵房间隔缺损(ASD)。均于术后即刻、术后6个月分别行超声心动图、心电图、X线胸片检查以评价治疗效果。结果同期介入治疗成功率100%,均无重要并发症发生,PBPV术后即刻右室收缩压由(81±26)mm Hg降至(38±12)mm Hg,跨肺动脉瓣压差由(68±24)mm Hg降至(15±13)mm Hg(P均<0.01),超声心动图测量ASD直径为3-16(10.3±8.4)mm,选择封堵器直径为8-20(12.4±8.2)mm,2例存在微-少量残余分流,14例封堵完全无残余分流。术后即刻、术后6个月超声心动图未见残余分流。结论经导管同期治疗儿童法洛三联症是一种安全有效的方法,成功率高,近期疗效可靠。     

非体外循环小切口房间隔缺损封堵术的应用

目的 介绍及推广一种闭合房间隔缺损的小切口非体外循环手术方法.方法 2004年9月至2007年4月我院收治房间隔缺损患儿46例(男22例,女24例);年龄8个月～16岁,其中8个月～1岁共11例,1～5岁共18例,5岁以上17例,体重8.5～35 kg,房间隔缺损直径8～25 mm,均为继发孔中央型.全组均在全麻下经右胸壁第四肋间小切口入胸.通过食管超声术中监测各切面房间隔大小及边缘情况,选择相应大小封堵器并经右房置入封堵器,行推拉试验确认牢固后释放封堵器.结果 45例房间隔缺损患儿封堵成功,1例失败.房间隔缺损直径8～25mm,房间隔各边缘最短分别距二尖瓣瓣根部7 mm、距左房顶8 mm、距上腔静脉6 mm、距下腔静脉6 mm.术后房间隔水平无分流,无明显手术并发症.结论 经右胸小切口非体外循环下房间隔缺损封堵术损伤小、无辐射、操作简单、安全性高,具有临床应用价值.     

小儿房间隔缺损介入治疗40例临床报告

目的 评价小儿继发孔型房间隔缺损(ASD)应用美国AGA公司的Amplatzer封堵器介入治疗的临床疗效。方法 Ⅱ孔型ASD40例。男16例,女24例;年龄3～15岁,平均10．2岁。体重11～87kg,平均35．8kg.6例合并肺动脉瓣狭窄(PS),1例合并二尖瓣脱垂和轻度关闭不全,l例台并室性心动过速(VT)。40例均采用美国AGA公司的AmplatzerASD封堵器。术中常规行右心导管检查,测量右室、肺动脉压力。经导引钢丝导人球囊导管测ASD最大伸展直径。用体表经胸超声心动图(TTE)或食道超声(TEE)测量房间隔直径及确定ASD的位置及大小。根据球囊最大伸展直径选择等于或大于l～2mm型号的ASD封堵器。结果 40例患儿应用40个Amplatzer封堵器封堵成功,成功率100%。经TTE测量ASD直径为7～30mm(平均17．12mm),TEE测量直径为7～32mm(平均18．44mm)。最大球囊伸展直径为8～34mm(平均20．56mm)。Amplatzer封堵器型号8～38mm(平均21．44mm)。合并PS,先行球囊扩张术,成功后再封堵ASD。合并VT先行射频消融术而后成功封堵ASD.40例无并发症,无残余分流。术后3—4天出院。术后3d复查ECG、TTE及X线胸部检查有明显改善。结论 AmplatzerASD封堵器封堵小儿ASD是安全、有效的。规范化治疗。严格掌握适应证是成功的保证。     

单纯食管超声引导经皮封堵治疗房间隔缺损

目的 通过与传统放射线引导方法相比较,评价单纯经食道超声(TEE)引导在经皮介入封堵儿童房间隔缺损中的早期临床应用效果.方法 收集2012年10月至2014年1月单纯TEE引导下经皮房间隔缺损封堵患儿50例(TEE组),均采用TEE引导并监测封堵全过程.选取同期传统放射线引导下经皮房间隔缺损封堵患儿162例为对照组.2组患者均于术后1个月在门诊随访,并行经胸超声心动图检查.结果 2组患儿年龄、体质量、房间隔缺损直径、封堵器直径、手术时间及住院时间无明显差异.TEE组和对照组封堵器置入成功率分别为100.0％和97.5％,2组比较差异无统计学意义(P=0.58);术后即刻残余分流发生率分别为0和4.4％,2组比较差异无统计学意义(P=0.20);气管插管时间分别为(2.9±0.5)h和0.术后随访1个月,2组患者均无残余分流,未发生外周血管损伤、心脏穿孔、封堵器脱落等严重并发症.结论 单纯TEE引导下经皮介入封堵儿童房间隔缺损不仅能够完全避免放射线及对比剂,而且保持了传统经皮介入治疗安全、微创的优点.     

改良切口经胸微创封堵术治疗膜周室间隔缺损

目的 探讨改良切口经胸微创室间隔缺损封堵术的可行性和安全性.方法 2011年5月至2015年5月,289例单纯膜周室间隔缺损患儿在我中心接受改良切口经胸室间隔缺损封堵术.该操作采用长约1～2 cm的微创切口,无需损伤胸骨,完全食道超声引导下完成室间隔缺损封堵.术后1、3、6个月定期随访.结果 289例患儿中,277例(95.8％)成功完成微创封堵;12例封堵失败,改行常规外科修补术.277例患儿均经改良微创切口入路,切口长度1～2cm,平均(1.53±0.46)cm.均未损伤胸骨,亦未放置引流管.术后早期均未出现心包积液.膜周室缺直径平均(5.30±2.88)mm.封堵器大小4～12mm,平均(6.70±3.10)mm,包括对称封堵器191例,偏心封堵器86例.12例(4.3％)患儿术中存在少量残余分流.9例(3.2％)术后发生不完全性右束支传导阻滞;1例患儿于术后4d出现完全性房室传导阻滞,经激素治疗5d后好转.所有患儿平均住院时间(3.2±0.8)d,随访期间,没有主动脉瓣反流、恶性心律失常、封堵器脱落等严重并发症发生.至随访结束仍有4例(1.4％)存在少量残余分流.结论 改良切口经胸壁微创封堵术,不损伤胸骨,可以有效治疗膜周室间隔缺损.但其长期疗效尚需进一步随访研究.     

165例5岁以下小儿房间隔缺损的介入治疗

目的总结双盘封堵器(Amplatzer)关闭年龄小、体重轻患儿的继发孔型房间隔缺损(ASD)的病例。方法1998年8月至2004年5月,165例5岁和18kg以下小年龄组继发孔型ASD病例接受Amplatzer封堵器介入治疗。所有患儿均经临床体检、X线胸片、心电图、经胸超声心动图(TTE)确诊为继发孔型ASD。TTE观察和测量ASD和房间隔(IAS)最大径,测量球囊导管测量ASD最大伸展径,必要时加用食道超声(TEE)测定,筛选后的患儿依此选择封堵器。结果163例成功封堵ASD,成功率98.8%。本组ASD最大径(8～30)mm,平均(18.3±5.1)mm,选择封堵器直径(8～30)mm,平均(18.6±5.0)mm,P>0.05。Qp/Qs=3.3±2.0。147例(89.0%)为单纯单孔ASD病例;6例为多孔ASD,其中3例伴有房间隔瘤样改变,均用一个封堵器成功封堵ASD。另外12例合并其他心内畸形,其中6例合并肺动脉瓣狭窄(PS),6例合并动脉导管未闭(PDA)。右心容量超负荷术后明显改善。本组中大ASD占60.0%(100)例。操作上有一定难度。结论Amplatzer封堵器关闭5岁以下儿童房间隔缺损是可行的,但不主张2岁以下行介入治疗。严格掌握适应证;良好的小儿心血管内外科条件是成功封堵的基本保证。     

Measurement of Atrial Septal Defect Size: A Comparative Study Between Three-Dimensional Transesophageal Echocardiography and the Standard Balloon Sizing Methods

Atrial septal defect (ASD) size measurement is of paramount importance for the successful deployment of a transcatheter septal occluder. The stretched balloon diameter (SBD) has long been regarded as the gold standard for selection of the size of any device. Three-dimensional (3-D) transesophageal echocardiography (TEE) can visualize the overall structure of the atrial septum, therefore rendering an accurate size of the ASD. In this study we aimed to validate the accuracy of ASD size measurement by 3-D TEE and to elucidate the reason for the difference between balloon sizing and 3-D measurement. Forty-one consecutive patients were enrolled in this protocol for ASD device closure using the Amplatzer septal occluder. Thirty-nine patients were diagnosed by 2-D transthoracic echocardiography as secundum ASD and 2 patients were diagnosed as patent foramen ovale. Two measurements of the balloon size were sequentially obtained by 2-D TEE after the balloon was fully inflated in the left atrium. First, no residual shunt across the septum could be seen while the balloon was pulled back against the septum. This measurement was called the balloon occlusive diameter (BOD). Second, with balloon deflation, a slight deformity of the balloon was seen just prior to its popping through the septum. This measurement was called the stretched balloon diameter (SBD). Three-dimensional TEE was performed in all patients at the beginning of the procedure before device deployment and within 15 minutes after device release. Three-dimensional TEE provided superior views of the ASDs, showing the spatial relationship between the ASD and the neighboring structures. For maximal ASD size measurement, balloon sizing was larger than 3-D TEE examination, whereas 2-D was smaller than the other two methods. The best correlation was found between 3-D TEE measurements and the BOD (r= 0.98, p < 0.0001). Three-dimensional TEE provides en face view of ASD; thus, it can accurately measure the size of ASD. Three-dimensional TEE measurement of ASD can be used instead of balloon sizing for the selection of transcatheter ASD occluder size.     

Transthoracic Echocardiography Guidance of Transcatheter Atrial Septal Defect Closure in Children

Transesophageal echocardiography (TEE) guidance is part of interventional closure of secundum atrial septal defect (ASD) in children and adults. However, sometimes TEE is impossible for technical or anatomical reasons. If available, intracardiac echocardiography can be used, but especially in children, transthoracic echocardiography (TTE) can be an easy, safe, and cheap alternative. We report two cases in which TEE was replaced by TTE during percutaneous ASD closure. In the first case VACTERL association with a surgically repaired tracheoesophageal fistula was a relative contraindication to TEE. In the second case, technical failure of the transesophageal probe occurred during the procedure. In both cases the ASD was successfully closed with an atrial septal occluder device under TTE guidance. Using TTE can be sufficient and safe in children with good imaging windows, especially from subcostal views.     

Valvuloplasty with large trefoil balloons for the treatment of congenital pulmonary stenosis

Percutaneous balloon valvuloplasty was performed in 16 children, 1 1/2 to 14 years old, with congenital pulmonary stenosis with teh use or trefoil balloons. These balloons, which consist of 3 identical angioplasty balloons, do not interrupt completely the blood flow during inflation. The size of the trefoil balloons used was 30 to 50% larger than the valve anulus. A obtain an effective pulmonary valvuloplasty in two patients with large valve anulus. The mean prevalvuloplasty systolic gradient fo 78.2 +/- 28.9 mmHg (range 40 to 140 mmHg) was reduced to 20.3 +/- 5.7 (range 10 to 30 mmHg) after valvuloplasty. No patient developed significant hypotension or bradycardia or other complications as a result of the procedure. The findings demonstrate that percutaneous balloon valvuloplasty with oversized trefoil balloons effectively treated congenital pulmonary stenosis without complications in the cases studied. The use of large trefoil instead of single balloons of a similar diameter is advantageous since they cause no significant compromise of the cardiac output during valvuloplasty.     

6月龄以下小婴儿危重型肺动脉瓣狭窄经皮球囊肺动脉瓣扩张成形术治疗的随访报告

目的 探讨经皮球囊肺动脉瓣扩张成形术(percutaneous balloon pulmonary valvuloplasty,PBPV)治疗新生儿和6月龄以下小婴儿危重型肺动脉瓣狭窄(critical pulmonary stenosis,CPS)的疗效以及早中期随访.方法 采用PBPV治疗34例日龄波动于13～175 d的新生儿以及小婴儿CPS,并进行了6个月～4年的临床随访.记录患儿PBPV前后右室收缩压(right ventricular systolic pressure,RVSP),肺动脉瓣跨瓣压差(transvalvular peak to peak systolic gradient,△P)以及PBPV术后采用心脏彩色多普勒动态监测的肺动脉瓣跨瓣压差的动态变化.结果 34例中32例(94%)完成PBPV术,1例术后2 h内死亡,2例心包积血,3例术中小球囊预扩张后换用合适球囊完成PBPV术,3例右室流出道痉挛,1例术后30 min右下肢股动脉搏动减弱.28例PBPV成功,RVSP由(96±28)mm Hg(1 mm Hg=0.133 kPa)下降至(49±20)mm Hg(下降49%,P＜0.01),△P由(89±25)mm Hg下降到(25±12)mm Hg(下降72%,P＜0.01),右室/主动脉收缩比值1.2±0.5下降到0.7±0.3(P＜0.01).随访6个月～4年,3例失访,5例(其中3例新生儿)因残余压超过40 mm Hg行第二次PBPV术,23例彩色多普勒心脏超声监测肺动脉瓣跨瓣压有进一步下降到(20±13)mm Hg,无明显的肺动脉瓣反流,无需进一步处理.结论 对于6个月以下小婴儿CPS,PBPV仍有效,安全的治疗方法并具有相对好的短中期疗效.

Abstract：

Objective To evaluate the effect and results of short and medium periods of follow-up of percutaneous balloon pulmonary valvuloplasty for critical pulmonary stenosis of neonates and infants under 6 months of age. Methods Between January 2002 and December 2008, 34 consecutive patients aged from 13to 175 days with critical pulmonary valvular stenosis underwent percutaneous balloon valvuloplasty. Patients records, catheterization data, angiograms and echocardiograms were reviewed. Patients were followed up for 6 months to 4 years ( mean 25.5 months ) by means of clinical examination and Doppler echocardiography.Results The pulmonary valvuloplasty was accomplished in 32 (94%) of 34 attempts. Immediately after dilation, right ventricular systolic pressure (RVSP) decreased from (96 ±28) mm Hg ( 1 mm Hg =0. 133kPa ) (49 ± 20 ) mm Hg ( P ＜ 0. 01 ), the transvalvular peak to peak systolic gradient (△P) decreased from (89±25) mm Hg to (25 ± 12) mm Hg (P ＜0.01 ), and the right ventricular/aortic systolic pressure ratio decreased from 1.2 ± 0. 5 to 0. 7 ± 0. 3 ( P ＜ 0. 01 ). One patient died because of cardiac tamponade following rupture of the pulmonary valve annulus, 2 patients developed pericardial effusion, 3 patients had infundibular spasm, 3 patients had a pre-dilation by small balloon and 1 patient had weakened femoral artery pollex. After a follow up period of 6 months to 4 years 3 of 31 patients lost to follow-up. Repeat valvuloplasty was performed in 5 patients (3 neonates), no patient required surgery, and the other 23 patients did not undergo further intervention, a mean peak systolic Doppler gradient of (20 ± 13) mm Hg was found and no significant pulmonary regurgitation was seen. Conclusions Percutaneous balloon pulmonary valvuloplasty was effective and safe for the treatment of critical pulmonary stenosis of neonates and infants under 6 months of age with good short and medium term results.     

新生儿危重肺动脉瓣狭窄及闭锁的经导管介入治疗

目的 探讨新生儿期采用经导管介入方法 治疗危重肺动脉瓣狭窄(critical pulmonarystenosis,CPS)及室间隔完整型肺动脉瓣闭锁(pulmonary atresia with intact ventricular septum.PA/IVS)的可行性.方法 2006年6月至2008年1月,采用经导管介入治疗13例新生儿(其中1例早产儿)危重先天性心脏病(CPS 9例,PA/IVS4例).男10例,女3例,年龄2～30(17.4±10.7)d,体重2.3～4.8(3.4±0.8)kg.术前及术中均使用前列腺素E.开放动脉导管.CPS患儿先采用直径2.5～4.0mm小球囊预扩张肺动脉瓣,再用1.0～1.2倍于肺动脉瓣环的球囊扩张肺动脉瓣.PA/IVS患儿先行射频瓣膜打孔,然后再行球囊瓣膜扩张术.结果 12例(92%)介入治疗成功.右室压力下降50%[术前(120.1±17.0)mm Hg(1 mm Hg=0.133 kPa),术后(58.8±7.7)mln Hg,P＜0.001].右室压力/体动脉压力比值下降44%[术前(1.6±0.2),术后(0.9±0.1),P＜0.001].右室造影显示肺动脉瓣开放.球囊/瓣环径比值1.1±0.1(最大球囊直径6～12 mm).手术时间(127.5±32.6)min,X线-曝光时间(25.2±7.2)min.术中4例(30%)出现并发症,2例心包积血,1例低氧血症,1例室上性心动过速.死亡1例(8%).全组随访1～18(7.2±6.4)个月.术后残余中至重度瓣膜狭窄3例,1例再次行球囊扩张术,另2例等待再次球囊扩张术;残余轻至中度瓣膜狭窄9例,所有患儿仅伴随轻度瓣膜反流,动脉导管自然闭合11例,近闭合1例.结论 经导管介入治疗新生儿CPS及PA/IVS是安全、有效的,部分患儿需二期介入治疗.     

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目的研究经胸超声心动图(TTE)在继发孔型房间隔缺损(ASD)介入治疗的病例筛选及封堵器选择方面的应用价值。方法回顾分析2002-03—2006-03于山东大学山东省立医院小儿心脏科行介入治疗的54例继发孔型ASD患儿,统计其术前TTE所测的ASD的形态、大小、边缘情况等,对术前TTE测得的ASD最大径、X线测得的球囊腰径及TTE测得的球囊径分别与所用封堵器型号大小进行统计学分析比较,并进行TTE测得的ASD最大径与封堵器型号大小的相关性分析,计算回归方程。结果54例均成功封堵,手术时间20~145(57.64±24.89)min,曝光时间3.1~31.5(9.22±7.41)min,住院天数3~10(5.74±1.72)d。其中有15例患儿存在ASD单一边缘不够标准,均封堵成功。术前TTE测得的ASD最大径[4~33mm,(16.31±7.34)mm]、术中X线测球囊腰径[6.7~28mm,(19.80±7.24)mm]及TTE测球囊径[9.6~24.8mm,(19.92±6.38)mm]与封堵器大小[5~36mm,(18.85±7.89)mm]差异均无显著性意义(P>0.05)。且术前TTE测得的ASD最大径与封堵器型号有良好的线性相关(r=0.945,P<0.05),计算回归方程为封堵器型号=1.015×(TTE测得的ASD最大径)+2.3mm。结论TTE的应用,使ASD介入治疗病例的筛选得到了保证。作为一种无创性影像学诊断方法,对ASD封堵器选择的评估有重要的应用价值。     

Valvuloplasty with Large Trefoil Balloons for the Treatment of Congenital Pulmonary Stenosis

ABSTRACT. Percutaneous balloon valvuloplasty was performed in 16 children, 1 1/2 to 14 years old, with congenital pulmonary stenosis with the use or trefoil balloons. These balloons, which consist of 3 identical angioplasty balloons, do not interrupt completely the blood flow during inflation. The size of the trefoil balloons used was 30 to 50 % larger than the valve anulus. A dual balloon technique employing a large trefoil and a smaller single balloon was used to obtain an effective pulmonary valvuloplasty in two patients with large valve anulus. The mean prevalvuloplasty systolic gradient of 78.2 28.9 mmHg (range 40 to 140 mmHg) was reduced to 20.3±5.7 (range 10 to 30 mmHg) after valvuloplasty. No patient developed significant hypotension or bradycardia or other complications as a result of the procedure. The findings demonstrate that percutaneous balloon valvuloplasty with oversized trefoil balloons effectively treated congenital pulmonary stenosis without complications in the cases studied. The use of large trefoil instead of single balloons of a similar diameter is advantageous since they cause no significant compromise of the cardiac output during valvuloplasty.