小儿先天性心脏病介入治疗进展

从1966年Rashkind等进行球囊房间隔造口术至今,先天性心脏病介入治疗已经经过了50余年的发展,从最初的导管检查、姑息手术到现在的根治性封堵、支架的植入及瓣膜的替换等,介入性心导管技术已经成为治疗先天性心脏病的主要手段之一。我国先天性心脏病介入治疗已取得长足进步,但与发达国家相比仍有一定差距,现就间隔缺损性疾病、主肺分流性疾病、瓣膜性疾病及内外科镶嵌治疗等介入治疗进展进行梳理总结,以期对我国先天性心脏病的介入治疗提供借鉴。     

先天性心脏病经导管介入治疗现状及进展

先天性心血管疾病的经导管介入治疗近年得到了长足的发展,介入治疗的方法不断增加,范围不断扩大.文章简要回顾小儿先心病经导管介入治疗的方法如球囊扩张成彤术治疗主动脉、肺动脉及其分支狭窄以及主动脉瓣和主动脉弓缩窄,血管内支架在肺动脉分支狭窄、体静脉狭窄、主动脉缩窄及在未闭动脉导管中的植入以及房、室间隔缺损的介入治疗等,同时介绍最新的一些研究进展,如经皮二尖瓣修复术、主动脉和肺动脉带瓣支架植入及外科手术中的介入治疗(内外科镶嵌治疗)等.     

先天性心脏病的介入治疗进展

先天性心脏病(先心病)发病率约1%,估计我国每年新增先心病患儿达15万左右,是小儿最常见的心脏病。对这些患儿,外科手术是传统的治疗方法,已有较丰富的经验和良好治疗效果,但外科手术需开胸和体外循环,对机体损伤较大,有一定手术并发症且留有疤痕。此外,有些动脉导管未闭(PDA)、房间隔缺损(ASD)、室间隔缺损(VSD)等外科手术后有一定残余分流,其中部分需再次手术治疗,这些都引起人们试图以微创介入治疗来代替外科手术治疗的尝试。先心病的介入治疗日新月异,治疗方法层出不穷,但基本可分为两大类。现将其简单介绍如下。一、扩张术类1.房间…     

导管介入治疗先天性心脏病32例

目的评价介入治疗对小儿先天性心脏病（先心）的疗效。方法选择先心患儿32例，在局部或基础麻醉下经导管心用Amplatzer封堵器治疗，术中经胸心脏彩色多普勒（TTE）及X线透视监测。分别于术后1～3d，3、6个月复查TTE与心电图各1次。结果31例封堵成功，成功率96．9％。术后1～3d，3、6个月体检及复查TTE与心电网，无血栓发生，无残余分流及瓣膜功能障碍，无腔静脉及肺静脉狭窄，无溶血及严重心律失常。结论介入治疗小儿先心创伤小，疗效好，安全且并发症少。     

先天性心脏病经导管介入治疗指南

先天性心脏病(简称先心病)的发病率为0．7％～0．8％,据此估计我国每年新出生的先心病患儿达15万左右,为小儿时期最常见的心脏病。20余年来,我国先心病的诊治工作取得了较大成绩,一方面是在婴幼儿及重症复杂型先心病的诊治,明显减少了死亡率;另一方面,先心病介入治疗在材料、实验、方法学、     

先天性心脏病介入治疗的回顾与展望

本世纪60年代中期Rashkind首先创用球囊房隔造口术替代外科开胸房隔切开术以缓解完全性大动脉转位与重症婴儿先天性心脏病（先心病）的低氧血症，以此开创先心病介入性治疗的新纪元。但直至70年代末由于球囊扩张导管的材料及冠状动脉扩张术的实验研究进展，于1982年Kan首先应用     

1100例小儿先天性心脏病经导管介入治疗护理经验总结

随着介入材料和器械、导管影像设备的迅速发展,经导管介入治疗已成为先天性心脏病（CHD）的重要治疗方法。据估计约45％的CHD可经导管介入治疗获得根治,而外科手术和介入联合的镶嵌（hybrid）治疗将使复杂CHD的治疗更趋完善合理。我院自1989年开始小儿CHD的介入治疗,16年来共有1100例小儿CHD得以根治,成为我省CHD介入治疗中心。其中术前、术中、术后的护理功不可没,并形成了一整套完善、合理的常规体系,现予总结报道。     

儿童常见先天性心脏病介入治疗的并发症分析

目的总结儿童先天性心脏病(CHD)介入治疗并发症的发生率,并分析其发生原因。方法回顾性分析2011年1月至2013年12月间2 356例诊断为室间隔缺损(VSD)、房间隔缺损(ASD)、动脉导管未闭(PDA)、肺动脉瓣狭窄(PS),并行介入治疗的0~18岁CHD患儿,在介入治疗中及治疗后发生并发症的情况。结果 2 356例CHD患儿中159例发生并发症,发生率为6.75%;其中VSD组为11.40%(82/719),ASD组为7.50%(51/680),PDA组为3.09%(22/712),PS组为1.63%(4/245)。心律失常发生率为4.41%(102/2 356)。严重并发症发生率为2.71%(64/2 356),VSD组为3.62%(26/719),ASD组为2.21%(15/680),PDA组为2.53%(18/712),PS组为1.63%(4/245);术中严重并发症为0.51%(12/2 356),术后早发严重并发症为1.99%(47/2 356),迟发严重并发症为0.21%(5/2 356)。严重并发症经介入手术治疗0.13%(3/2 356),经外科手术治疗0.64%(15/2 356),经内科保守治疗1.95%(46/2 356);2例死亡,死亡率0.08%。结论 CHD介入治疗的并发症及死亡率低,但仍不容忽视。术前严格掌握适应证,术中按常规操作,术后进行规范的长期随访至关重要。     

胎儿先天性心脏病介入治疗进展

既往观点认为,一旦胎儿患有左心发育不良综合征(HLHS)等严重心血管畸形,结局就只能是出生后功能性单心室循环、心脏移植或中止妊娠.到目前为止,开放性胎儿心脏外科技术尚不成熟,而通过胎儿心脏介入治疗技术可以在很大程度上阻止因先天性心脏病引起的胎儿水肿、自发性流产或胎儿死亡,促进发育不良的心室重新发育,形成生后的双心室循环,重塑右室流出道梗阻胎儿的肺血管床等,改善了胎儿严重心血管畸形的预后.这些进步在很大程度上依赖于对胎儿先天性心脏病病理生理学特点的准确判断.超声技术的发展以及其他评价手段的进步可促进目前还比较有限的胎儿先天性心脏病介入治疗进一步发展.     

先天性心脏病介入治疗的适应证

先天性心脏病(先心病)的介入治疗最初作为一种姑息疗法以缓解完全性大动脉转位等重症发绀型先心病患儿低氧血症,即采用球囊房隔造口术替代外科开胸房间隔切开术,使患儿能够存活至进行根治术年龄。而后Porstmann应用泡沫塑料堵塞法进行动脉导管未闭(PDA)封堵术获得成功,使经导管治愈单一畸形先心病成为现实,也极大地促进先心病介入疗法的飞速发展。目前先心病介入治疗技术可分为两类:1.扩张术类:包括球囊房隔造口术、瓣膜成形术(球囊肺动脉瓣成形术、球囊主动脉瓣成形术)及血管成形术(主动脉缩窄血管成形术、肺动脉分支狭窄血管成形术)等。…     

小儿先天性心脏病介入治疗的放射防护

小儿先天性心脏病的介人治疗在过去10多年来得到迅速发展,其创伤小、手术时间短、安全性好和不留癍痕的特点给临床带来很大帮助.与此同时,介入放射对小儿的高辐射剂量也引起了密切关注,开展了很多对患儿的辐射剂量测量和防护措施的研究,并提出了很多有价值的建议.该文将对小儿先天性心脏病介入治疗的放射防护进行综述.     

Renal involvement in patients with congenital cyanotic heart disease.

Patients with congenital cyanotic heart disease may develop a glomerulopathy with proteinuria and impaired renal function. In order to investigate this problem we conducted a study on 27 patients with uncorrected cyanotic heart disease who were between 1 day and 25 years old. As a consequence of hypoxaemia haematocrit was elevated to 57%. Proteinuria was above 150 mg/day/1.73 m2 body surface in 12 patients. Only one of 9 children under 10 years of age had pathological proteinuria presenting as isolated albuminuria. Seven out of 10 patients between 11 and 20 years had an elevated proteinuria with a glomerular pattern. Creatinine clearance was normal in these patients. All four patients above 20 years of age had a considerable glomerular proteinuria with a mean excretion of 5.7 g/24 h/1.73 m2 body surface. These patients suffered additionally from chronic cardiac failure and creatinine clearance was below the normal range. There was a clear relationship between pathological proteinuria and age of the patients and thus duration of hypoxaemia. Patients with pathological proteinuria had a significant higher erythrocyte count (7.3 +/- 1.3 vs 5.6 +/- 1.4 10(12)/l p less than 0.01) and a lower mean corpuscular haemoglobin. In summary, children with persistent congenital cyanotic heart disease have substantial risk of developing a glomerulopathy if the cyanosis remains unchanged for more than ten years.     

Nutritional treatment of congenital heart disease.

Twelve of 13 patients with congenital heart disease given continuous enteral nutrition displayed normal growth; cardiac function remained stable or improved in 10 in spite of the water load (146 +/- 22 ml/kg/day). This is safe treatment for malnutrition in congenital heart disease.     

COVID-19 and congenital heart disease:a case series of nine children

Background Coronavirus disease 2019(COVID-19)is the current pandemic disease without any vaccine or efficient treat-ment to rescue the patients.Underlying disea...     

Non surgical treatment in congenital heart disease

Dilation of blood vessels transluminally was demonstrated by Dr Andreas Gruntzig in 1978. In 1982, Kan demonstrated that congenitally stenosed valve can be dilated with the use of cylindrical balloon and opened up new vistas in the non-surgical treatment of congenital heart lesions. Rapid progress has been now made in (1) Understanding of mechanism of success or failure of balloon dilation (2) Development of newer hardwares like low profile balloon, high pressure ballons, extra support wires which have contributed to increase in success rate of the procedures (3) Understanding the unnatural history of various congenital heart lesions from the vast data bank of Registries of balloon dilation. As a consequence balloon dilation has become the first procedure of choice in the treatment of valvar pulmonary stenosis and post surgical recurrent coarctation. Although an essentially palliative procedure for the treatment of valvar aortic stenosis and native coarctation beyond the neonatal period, non-randomised studies have shown results similar to that of surgical correction. Balloon dilation of pulmonary artery, pulmonary vein, venous baffles stenosis have shown poor overall results. Balloon dilation for sub-pulmonary stenosis like tetralogy of Fallot is controversial. The development of stents to keep dilated vessel open has also found a place in treatment of congenital heart lesions. Thus pulmonary artery stenosis, recurrent coarctation in adults, venous baffle obstruction, conduit stenosis which respond poorly to balloon dilation alone have shown promising early and mid term results with stents. The use of stents to keep the ductus open, recurrent coarctation in children, in right ventricular outflow tract obstruction is controversial. Development of devices to achieve closure of cardiac defects is relatively new. Patent arterial duct was the first defect to be closed with the help of devices and has shown good results on long term follow up. Recently stainless steel coils have been used to close dose small ducti (up to 3 mm) with very promising medium term results. Its use has also been extended to larger ducti (up to 7 mm). Devices used for closing atrial septal defects, ventricular septal defects are undergoing rapid development. In atrial septal defects its use is restricted to small defects in the fossa ovalis area and in day for atrial septal closure are relatively new and await long term results. The results achieved by non surgical treatment for many congenital heart lesions are essentially palliative and may require repeat interventions at some point in the unnatural history which increases the cost of treatment substantially. The reuse of balloons, guide wires in developing countries helps reduce the overall cost of the procedure.     

Training pediatric residents to evaluate congenital heart disease in the current era

Working with young pediatricians to create an exciting educational environment in which to learn cardiology remains a challenge for all of us. Numerous forces impact our efforts, making the process of training residents to evaluate and treat congenital heart disease in the current era a dynamic and, at times, difficult endeavor. This article considers the changes that have occurred in the medical school graduate who chooses pediatrics and subsequently pediatric cardiology as a career; explores the changes in the graduate medical training guidelines, requirements, and restrictions that have been put into place within the last several years; and discusses the seemingly constant advances in scientific understanding and technology that shape our field and move us forward as a discipline.     

儿童先天性心脏病术后行膈肌折叠手术的临床观察研究

目的:分析儿童先天性心脏病(CHD)术后行膈肌折叠术(DPL)的危险因素、时机和临床疗效。方法:回顾性分析2017年1月至2019年12月在上海儿童医学中心行CHD手术患儿的临床资料,根据CHD术后是否行DPL分为DPL组和未行膈肌折叠术组(NDPL组),比较两组患儿年龄、CHD术式、术次、体外循环(CPB)时间等临床...