一站式"杂交"手术治疗婴幼儿先天性心脏病

目的 总结5年来应用一站式"杂交"技术(one-stop hybrid procedure,OHP)治疗2岁内婴幼儿和新生儿先天性心脏病(congenital heart disease,CHD)的经验.方法 自2004年3月至2009年3月,共152例低龄CHD患儿接受了OHP治疗,其中行球囊扩张72例、间隔缺损封堵43例以及体肺侧支栓塞37例.所有手术都在实时超声引导或血管造影辅助下在OHP专用手术室完成,并根据病情实施相应的常规外科手术.术后随访6个月,记录其心血管不良事件发生情况.结果 球囊扩张组72例实施肺动脉瓣或主动脉缩窄球囊扩张,扩张后2例发现右心室流出道仍显著狭窄,其中1例术中,1例术后3个月接受体外循环下流出道成形术;随访期间1例因肝功能衰竭死亡.间隔缺损组43例中2例房间隔缺损、1例室间隔缺损封堵失败转为体外循环下修补,1例室间隔缺损封堵后因术前肺部感染迁延不愈死亡,其余术后随访均末发现封堵器移位.体肺侧支栓塞组37例均无死亡.结论 OHP结合了影像学和外科技术,可以减少心脏切口并在最大程度上减少或避免体外循环对于低龄CHD患儿的损害.但OHP手术密切相关的影像学引导技术、介入器械改良等仍需进一步的研究.

One-stop hybrid cardiac surgery for neonates and young children with congenital heart disease

Objective To summarize our 5 years experiences of one-stop hybrid procedure (OHP) for the management of congenital heart disease (CHD) in neonates and young children (<2 years old). Methods Clinical data derived from consecutive 152 young children and neonates with CHD underwent OHP between March 2004 to March 2009 were analyzed. Patients were divided into 3 groups: Balloon plasty group (n=72), device closure group (n=43) and collateral arteries occlusion group (n=37). All procedures were image-guided and performed in a specially designed hybrid operation room. Incidence of major adverse cardiovascular events was obtained. Results Patients received successful per-ventricular valvuloplasty or per-aortic balloon angioplasty in balloon plasty group. Two patients in this group with severe right ventricle outflow obstruction received regular open-heart outflow tract rconstruction immediately (n= 1) or selective conventional open-heart operation after discharge (n=1). One neonate with pulmonary atresia with intact ventricular septum died from liver failure 6 month after OHP. In device closure group, device closure was failed in 3 cases (2 with atrial and 1 with ventricular septum defects), 1 young child with vcntricular septum defects died from pneumonia after successful device closure. No device malposition was observed in device closure group during the follow-up. All patients received major collateral arteries occlusion and open-heart correction were discharged without complication. Conclusion OHP could avoid or shorleu the application of cardiopulmonary bypass and reduce the surgical trauma in selected young children with CtiD. Although OHP was feasible and safe, the image outfits, image-guided technology and OHP-related device should be further developed and improved for better procedure outcome.