复合先天性心脏病同期介入治疗临床评价

目的 探讨先天性心脏病复合畸形经导管同期介入治疗的可行性、治疗策略和疗效.方法 2006年11月至2013年9月介入治疗先天性心脏病复合畸形共17例.先天性心脏病的复合畸形为室间隔缺损（VSD）并发房间隔缺损（ASD）7例,ASD并发动脉导管未闭（PDA）3例,ASD并发肺动脉瓣狭窄（PS）2例,VSD并发PDA 5例.介入治疗的顺序依次为肺动脉瓣球囊扩张术（PBPV）、VSD封堵术、PDA封堵术,最后行ASD封堵术.术后48 h,1～6个月随访检查心电图、X线胸片和超声心动图.结果 17例复合畸形均一次性治疗成功,手术成功率100％.并发症发生率5.9％ （1/17）,1例VSD并ASD术后发生残余分流伴溶血经治疗后停止,余随访无不良并发症发生.结论 严格掌握适应证,术中采取适当的治疗策略,操作规范,先天性心脏病复合畸形的同期介入治疗安全可行、有效,可获得满意的效果.

Clinical evaluation of simultaneous transcatheter therapy on combined congenital heart diseases

Objective To investigate the feasibility,therapeutic tactic and efficiency of simultaneous transcatheter therapy on combined congenital heart diseases.Methods Seventeen patients hospitalized from November 2006 to September 2013 with combined congenital heart diseases were selected as our subjects,and they included 7 cases with ventricular septal defects（VSD） and atrial septal defects（ASD）,5 cases with VSD and patent ductus arteriosus（PDA）,3 cases with ASD and PDA,2 cases with ASD and pulmonary stenosis（PS） They underwent transcatheter therapy simultaneously with the sequential algorithm as percutaneous balloon pulmonary valvuloplast y （PBPV） at first stage and then followed by the occlusion of VSD,PDA,ASD successively.Transthoracic echocardiography （TTE）,X-ray examination and electrocardiogram （ECG） were performed at 48 h,1-6 months after the procedure to evaluate the outcome of the procedure.Results All patients were cured and the cure rate was 100％.The complication rate was 5.9％ （1/17）.One case with VSD and ASD showed a small residual shunt with hemolysis at 6 hours later after operation and it disappeared at 14 days after operation through medicine therapy.No other complication occurred in follow-up periods.Conclusion Simultaneous transcatheter therapy of combined congenital heart diseases is feasible,safe and effective with satisfactory good results through strict indication selection,appropriate therapeutic tactics and standardized manipulations