经导管介入封堵儿童期主肺动脉窗3例报告并文献复习

目的总结经导管介入封堵儿童期主肺动脉窗的经验及疗效。方法对3例儿童期主肺动脉窗予以经导管介入封堵,其中男2例、女1例,年龄分别为11个月、14岁及2岁。1例属非限制性缺损,2例属限制性缺损。1例采用逆向法(主动脉端至肺动脉端)通过缺损,2例采用顺向法;1例采用肌部室间隔缺损封堵器,2例采用动脉导管封堵器。结果 3例病例均成功封堵,2例无残余分流;1例有中量残余分流,1个月后复查无残余分流。3例均无左冠状动脉、肺动脉阻塞及主动脉或肺动脉反流。结论经导管介入封堵儿童期大的(非限制性或限制性)主肺动脉窗是安全、可行的。选择介入的主肺动脉窗需是中间型,无伴发其他先天性心脏病。介入治疗具有明显减少不适感、不需体外循环、无手术瘢痕及缩短住院时间等优点。

Transcatheter closure of aortopulmonary window in children:three cases reports and literature review

Objective To summarize the experiences of transcatheter closure of aortopulmonary(AP)window in children.Methods From March 2002 to November 2010,three children,two boys(11 months and 2 years)and one girl(14 years),underwent successful transcatheter closure of AP window at our institution.One case had a nonrestrictive AP window with near systemic PA pressures,while other two cases had restrictive AP window.One case was used retrograde(aortic to pulmonary artery side)approach to cross the defect,other two case was used antgrade approach.Two cases used devices-duct occluder(6-8 mm,18-20 mm)and one case used,muscular ventricular septal defect occluder(18 mm).Results All procedures were successful(device released).Two cases had no residual shunting while the other one had a moderate residual shunting and was cured at 1 month follow-up.All cases were checked to ensure occlusion of the defect without impinging upon pulmonary artery and left coronary artery or aortic or pulmonary regurgitation.Conclusions Transcatheter closure of large(nonrestrictive or restrictive)AP window is safe and feasible in children provided the AP window is intermediate in type and unassociated with any other congenital cardiac anomaly.Significantly less discomfort,avoidance of cardiopulmonary bypass and surgical scar,and shorter duration of hospital stay make device closure the treatment of choice in such selected cases of AP window.