经皮肺动脉瓣球囊扩张治疗先天性肺动脉瓣狭窄临床应用研究

目的：评价经皮球囊成形术（PBPV）治疗肺动脉瓣狭窄（PS）的临床疗效。方法：20例病人,经临床、心电图、胸片及心脏超声诊断为单纯肺动脉瓣狭窄,扩张前确定PS的类型和测量瓣环大小,球囊直径选择比瓣环直径大20%～40%,扩张后即刻测肺动脉跨瓣压差,观察PBPV后,肺动脉瓣的开放,射流,跨瓣压差,三尖瓣及肺动脉瓣返流情况。结果：20例患者均用球囊扩张成功,跨瓣压差下降63.65%（P〈0.01）,1例出现肺动脉瓣轻度关闭不全,1例术中出现窦缓,用阿托品后消失,无任何严重并发症发生。结论：PBPV治疗肺动脉瓣狭窄具有成功率高、创伤小、并发症少等特点,可作为治疗PS的首选方法。     

经皮球囊肺动脉瓣膜成形术治疗小儿肺动脉瓣狭窄

目的 :探讨经皮球囊肺动脉瓣膜成形术 (PBPV)治疗小儿先天性肺动脉瓣狭窄的临床效果。方法 :7例单纯先天性肺动脉瓣狭窄 (PS) ,根据患儿的年龄和 PS的轻重 ,3例选择单球囊法 ,4例采用双叶球囊法 ,进行瓣膜扩张术。结果 :7例患儿 PBPV术后 ,即时跨瓣压力阶差 (Δ P)均显著下降 (ΔP<2 0 mm Hg)。结论 :PBPV是简便、安全、经济的治疗PS的首选方法     

经皮球囊肺动脉瓣狭窄成形术中X线有关问题

本文通过10例经皮球囊肺动脉瓣狭窄成形术的体会,讨论了有关适应症、肺动脉瓣环测量、球囊导管的选择及扩张中X线所见等问题。主张应用低压手推法、短的阻塞时间、少的扩张次数,如条件允许易多采用双囊法。     

经皮球囊肺动脉瓣成形术

经皮球囊肺动脉瓣成形术（PBPV）是近几年才开展起来的心血管疾病治疗领域里的世界先进技术。这种不需开胸开心的非外科手术疗法创伤小、疗效高，无严重并发症，康复快，患者愿意接受。本文报告了国内首次采用聚乙烯双叶式球囊导管成功地分离了3例先天性心脏病、肺动脉瓣狭窄（CHD，PS）的病人，效果满意。     

双球囊导管扩张治疗成人肺动脉瓣狭窄

自从球囊导管扩张治疗肺动脉瓣狭窄取得成功以来,由于该方法简便、疗效确切,目前已日益受到重视和推广.本法治疗患者多为儿童,年龄一般不超过20岁,40岁以上尤为少见[1].我院于1998年3月收治1例年龄为47岁患者,采用双球囊导管扩张治疗肺动脉瓣狭窄,效果良好,报道如下.     

先天性心脏病介入治疗106例临床分析

目的探讨先天性心脏病（CHD）经皮介入治疗方法及其近期疗效。方法回顾分析106例连续施行的CHD介入治疗患者的临床资料,其中单一病变99例,复合病变7例;包括动脉导管未闭（PDA）28例,房间隔缺损（ASD）35例,室间隔缺损（VSD）18例,肺动脉瓣狭窄（PS）18例,PS合并ASD3例,PDA合并ASD2例,PS合并PDA1例,ASD合并VSD1例。结果106例介入成功101例,5例未封堵成功,成功率95.3%。封堵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20mmHg以下。结论CHD介入治疗成功率高、创伤小,近期临床疗效好。     

经皮球囊肺动脉瓣扩张术治疗肺动脉瓣狭窄

目的 :寻找治疗肺动脉瓣狭窄的有效方法。方法 :3例肺动脉瓣狭窄患者 ,经股静脉穿刺 ,心导管测量右心室和肺动脉压力及右心室造影后 ,插入一定外径的球囊导管 ,以 4atm的压力在3～ 5s内充盈球囊 ,扩张肺动脉瓣至球囊腰状征消失。结果 :经球囊扩张后 ,病人的右心室压和肺动脉跨瓣压差均下降至正常 ,右心室造影显示肺动脉瓣狭窄征象消失。无并发症发生。随访 2～ 1 0个月 ,疗效进一步提高。结论 :经皮球囊肺动脉瓣扩张术可以替代外科手术治疗肺动脉瓣狭窄 ,该方法简便、安全、有效、创伤小 ,易被病人接受。     

食管球囊扩张术治疗食管癌术后吻合口狭窄效果分析

目的：探讨食管球囊扩张食管癌术后吻合口狭窄的疗效。方法用直径18～22 mm的球囊导管对30例食管癌术后吻合口狭窄患者扩张治疗。结果30例食管癌患者中一次性治愈16例（53.3％）,2次治愈10例（33.3％）,3次治愈4例（13.4％）,吞咽困难缓解率100％,无严重并发症和复发。结论球囊导管扩张食管癌术后吻合口狭窄是理想的治疗方法。     

经皮球囊肺动脉瓣扩张术治疗肺动脉瓣狭窄

目的：寻找治疗肺动脉瓣狭窄的有效方法。方法：３例肺动脉瓣狭窄患者,经股静脉穿刺,心导管测量右心室和肺动脉压力及右心室造影后,插入一定外径的球囊导管,以４ａｔｍ的压力在３～５ｓ内充盈球囊,扩张肺动脉瓣至球囊腰状征消失。结果：经球囊扩张后,病人的右心室压和肺动脉跨瓣压差均下降到正常,右心室造影显示肺动脉瓣狭窄征象消失。无并发症发生。随访２～１０个月,疗效进一步提高。结论：地皮球囊肺动脉瓣扩张术可以夫代     

胸骨下小切口经胸介入治疗复合先天性心脏畸形经验初探

目的 总结经胸介入治疗多种复合先天性心脏畸形的经验。方法 对21例有复合心脏畸形患儿（复合畸形组）和32例单纯心脏畸形患儿（单纯畸形组）均行经胸骨下端纵切口（2-3 cm）经胸介入治疗,先天性室间隔缺损（VSD）、房间隔缺损（ASD）、动脉导管未闭（PDA）采用相应封堵器,肺动脉瓣狭窄（PS）采用球囊扩张。结果 患儿均存活,无重大并发症,且两组患儿在手术时间、机械通气时间、监护时间、术后时间、用血量方面比较差异均无统计学意义（P〉0.05）。结论 单一胸骨下小切口治疗复合心脏畸形能达到治疗目的,且切口小而美观。     

INONUE球囊经皮肺动脉瓣成形术治疗成人肺动脉瓣狭窄临床疗效分析

目的：探讨应用Inoue球囊经皮肺动脉瓣成形术（PBPV）治疗成人肺动脉瓣狭窄（PVS）的临床疗效.方法：成人PVS患者56例,采用PBPV进行治疗,并以超声多普勒评价其疗效.结果：56例行PBPV患者术后即刻右心室收缩压由（103.4±27.2）mmHg（1mmHg=0.133kPa）降至（49.5±17.6）mmHg（P〈0.01）,右房压由（17.2±5.5）mmHg降至（9.2±4.4）mmHg（P〈0.01）,肺动脉压由（14.8±3.2）mmHg升至（22.1±5.3）mmHg（P〈0.05）,肺动脉与右心室跨瓣压差（△P）由（78.2±26.1）mmHg降至（22.8±12.4）mmHg（P〈0.01）.多普勒超声随访：术后3mo△P较术后即刻进一步显著下降（P〈0.05）.结论：INONUE球囊PBPV治疗成人PVS安全有效.     

带单瓣自体心包补片在右室流出道重建术中的临床研究

目的 研究带单瓣自体心包补片在右心室流出道重建术中的应用价值.方法 2006一07/2010-12月期间收治的48例复杂先天性心脏病患者行右心室流出道重建手术,其中法洛四联症(tetralogy of Fallot,TOF)21例,法洛四联症合并肺动脉闭锁(pulmonary atresia,TOF+PA)12例,右心...     

Lecompte手术临床应用报告

目的 验证Lecompte手术治疗合并室间隔缺损(ventricular septal defect,VSD)和肺动脉瓣狭窄(pulmonary stenosis,PS)的完全性大动脉转位(complete transposition of great arteries,TGA)和右室双出口(double outlet...     

Yagel法在产前超声诊断胎儿先天性心脏病的临床研究

目的通过应用Yagel法胎儿心脏超声检查探讨产前超声诊断胎儿先天性心脏病的可行性及临床应用价值。方法收集2008年2月—2010年2月在我院行产前胎儿超声检查的孕妇共4415例,孕周20～36周。应用Yagel法筛查4415例胎儿先天性心脏病的发生情况。Yagel法筛查切面包括：①胎儿腹部胃泡横切面;②四腔心切面;③五腔心切面;④大动脉短轴切面;⑤三血管气管切面。随访胎儿预后,计算Yagel法诊断胎儿先天性心脏病的敏感度及特异度。结果 4415例胎儿中,应用Yagel法诊断先天性心脏病共18例：①室间隔缺损5例;②房室间隔缺损3例;③肺动脉瓣狭窄1例;④复杂性先天性心脏病9例：右室双出口、完全性大动脉转位、永存动脉干各3例;漏诊2例,误诊1例,先天性心脏病的发病率0.45%（20/4415）。Yagel法诊断先天性心脏病的敏感度90%（18/20）,特异度99.9%（4394/4395）。结论 Yagel法胎儿心脏超声检查是产前筛查和诊断胎儿先天性心脏病的简单、有效的方法,具有良好的临床应用前景。     

小儿先天性气管狭窄矫治术及术后处理

目的：总结小儿先天性气管狭窄（CTS）矫治术以及术后管理体会。方法：2006年5月～2011年1月,我院收治小儿CTS 12例,男7例,女5例;年龄22 d～13岁,平均（5.0±2.1）岁;体重2.1～48.0 kg,平均体重（10.2±3.7）kg。按照Grundfast法分期,Ⅰ期CTS 1例,Ⅱ期4例,Ⅲ期5例,Ⅳ期2例。合并畸形包括肺动脉吊带6例,动脉导管未闭（PDA）5例,房间隔缺损（ASD）4例,室间隔缺损（VSD）6例,中度肺动脉狭窄（PS）1例,法洛四联症1例,肺动脉高压2例,右室双出口3例,双腔右心室3例,永存左上腔静脉2例。采用胸骨正中切口,体外循环辅助下先天性气管狭窄矫治,同期纠正合并其他畸形。结果：气管端端吻合术5例,Slide气管成形术3例,自体游离气管片移植术3例,心包补片移植术1例。手术死亡1例,死亡率为8.3%。术后主要并发症有低氧血症（7例）和低心排（6例）。术后采用改良超滤7例,延迟关胸4例,呼吸机辅助9例,体外膜肺5例,静脉应用正性肌力药物4例。术后6个月～2年随访中,除2例轻度支气管狭窄外,心肺功能均良好。结论：同期纠治小儿CTS和并发并畸形的手术效果良好。防治术后低氧血症和低心排是降低CTS术后病死率的关键,包括施行改良超滤、延迟关胸、体外膜肺和预防性静脉应用强心药物等措施。此外,加强基础护理、营养支持、预防感染也很重要。     

经T管介入治疗胆管疾病术后胆管狭窄的临床应用

目的探讨经T管途径介入治疗胆管疾病外科术后胆管狭窄的临床价值。方法回顾性分析2005年2月—2012年12月因胆管疾病接受外科手术并留置T管引流后继发胆管狭窄的19例患者的临床资料,其中男12例,女7例,年龄45～70岁,平均57．4岁。原发疾病分别为肝门部胆管癌8例,胆总管结石6例,胆囊癌5例。经T管造影证实,12例T管短臂下支开口狭窄或梗阻,5例T管上支和下支均狭窄或梗阻,1例T管上支开口狭窄,1例T管上支开113狭窄和胆管瘘继发胆汁瘤。所有患者在数字减影血管造影（DSA）透视下经T管途径予以介入治疗。结果6例经T管下支置人多侧孔导管予以胆汁内引流,4例经T管上支置入pigtail导管予以外引流,3例经T管置入球囊导管扩张上、下支狭窄,2例经T管下支置人镍钛合金胆管支架,2例经T管下支置入镍钛合金可回收胆管支架,1例采用经皮肝穿刺胆管引流（PTCD）联合经T管置入导管行胆汁内转流,1例经T管置入导管引流胆汁瘤并予弹簧圈栓塞胆管瘘。术后胆管梗阻症状明显缓解,随访1—6个月,2例因肿瘤衰竭死亡;2例患者出现再狭窄,予以再次PTCD引流。结论对于胆管疾病外科术后留置T管再发胆管狭窄的患者,可经T管途径采用置管引流、球囊扩张、支架置入等介入技术再次治疗,该技术操作简便、安全、微创。     

右腋下小切口心脏不停搏修补房室间隔缺损24例临床分析

目的:总结右腋下小切口心脏不停搏房室间隔缺损修补术的临床经验。方法:对24例房室间隔缺损等先天性心脏病均采用右腋下小切口体外循环下心脏不停搏手术进行矫治,其中2例合并部分型肺静脉异位引流(partial anomalous pulmonary venous connection,PAPVC)者扩大房缺,并用补片将引流到右房的右肺静脉隔到左心房,2例合并肺动脉瓣狭窄者行瓣叶交界处切开,3例合并三尖瓣关闭不全者行三尖瓣成形术。结果:全组无手术死亡,无残余分流、气栓、低心排血综合征等并发症。2例手术中分别损伤右房后壁及右下肺静脉,1例出现一过性血红蛋白尿,1例出现心律紊乱。结论:右腋下小切口体外循环下心脏不停搏手术方法具有微创意义,但使用有一定局限性,应建立在安全、精确的心脏畸形纠治基础上。     

Treatment of vein graft stenosis by balloon catheter dilation.

Percutaneous balloon catheter dilation was used to treate 12 high-grade stenoses in ten autogenous vein bypass grafts since September 1978. Four lesions occurred in femoropopliteal grafts, seven in femorotibal grafts, seven in femorotibial grafts, and one in an axillofemoral graft. Balloon catheter dilation was successful and surgery avoided in 11 of the 12 lesions. Pedal pulses were restored in eight of the ten patients, and the pulse in a femorotibial bypass graft was improved in another. Postdilation arteriography demonstrated a substantial increase in luminal diameter, and ankle pressure indexes were improved in all successful cases. The tenth had an operative correction of the stenosis. There were no complications with the procedure. Percutaneous balloon catheter dilation appears to be an effective method of treating stenosis in autogenous vein grafts and a useful alternative to surgical revision.     

Hemodynamic evaluation and morphological changes of right ventricular out-flow tract and pulmonary valve after balloon pulmonary valvuloplasty

Balloon pulmonary valvuloplasty (BPV) was attempted in 38 cases of congenital pulmonary valve stenosis. It was effective and was done without complication in 36 cases, however it was not effective in two cases of pulmonary valve dysplasia. The balloon used was 20-50% larger in diameter than the pulmonary valve annulus. In the seven cases in which the transvalvular pressure gradient was above 100 mmHg on cardiac catheterization, right ventriculography demonstrated that the functional obstruction of the right ventricular outflow tract increased immediately after BPV, however it subsequently improved at one year after the procedure. At between one and three months after BPV, two-dimensional echocardiography demonstrated that the morphological obstruction to the right ventricular outflow tract had diminished. In two cases, localized right ventricular septal hypertrophy with severe pulmonary valve stenosis was observed by two-dimensional echocardiography and right ventriculography, and persisted at one year. In all cases, two-dimensional echocardiography and angiography demonstrated doming pulmonary valves with valve stenosis, which was diminished by BPV. The pulmonary valve morphology was observed by two-dimensional echocardiography in three cases following BPV. In one case, partial relief of pulmonary valve obstruction was seen to be due to commissural splitting and in the other two, to tearing of cusp tissue. Inspection of the pulmonary valve at operation was made in one case who underwent elective surgery for repair of an atrial septal defect which was associated with pulmonary valve stenosis. It demonstrated partial relief of pulmonary valve stenosis by tearing of cusp tissue. In conclusion, BPV is as effective a treatment for congenital pulmonary valve stenosis as open valvulotomy. In our follow-up study, it has shown no apparent complications. The transient obstruction in the right ventricular outflow tract immediately after BPV improved within one month and improved further after three months and one year. However, in the more long-standing cases the localized right ventricular septal hypertrophy persisted and these cases will require, a long term follow-up.