外科手术治疗先天性心脏病介入封堵术后并发症-附10例分析

目的:总结外科开胸手术方法治疗介入封堵动脉导管未闭(PDA)、房间隔缺损(ASD)和室间隔缺损(VSD)术后并发症。方法:对1995年至2010年10例PDA、ASD、VSD采用介入封堵后出现并发症而进行外科手术治疗的病例进行回顾性分析。其中严重主动脉瓣反流、三尖瓣反流各1例,Ⅲ°房室传导阻滞2例,封堵器移位5例,介入装置释放困难1例。10例患者均采用全麻体外循环下心脏直视手术,取出堵闭器、矫治心脏畸形。结果:10例患者均成功取出堵闭器,心脏畸形矫治满意,外科手术中开放升主动脉全部自动复跳,顺利脱机。10例患者中9例术后恢复良好,1例因肾功能衰竭及多脏器功能衰竭死亡。结论:PDA、ASD及VSD介入封堵治疗创伤小,术后恢复快,疗效肯定,但也存在一定的手术风险和出现严重并发症的可能。及时地行外科手术可以避免病情恶化、矫治心脏畸形,术后心功能恢复良好。

Surgical treatment of complications of congenital heart defect after unsuccessful interventional treatment: a report of 10 cases

Objective:To summarize surgical treatment of complications of unsu-ccessful interventional treatment for patent ductus arteriosus(PDA),atrial septal defect(ASD) and ventricular septal defect(VSD).Methods:A total of 10 patients who underwent surgical treatment of unsuccessful interventional treatment of PDA,ASD and VSD from 1995 to 2010 were included in this retrospective analysis.Comp-lications of interven-tional closure included severe aortic regurgitation in 1 case,severe tricuspid regurgitation in 1 case,Ⅲ° atrio-ventricular block(Ⅲ°AVB) in 2 cases,occluder displacement in 5 cases and failed in releasing of occluder in 1 case.All the 10 patients underwent open heart surgical occluder removal and cardiac defects correction under general anesthesia and extracorporal bypass.Results:All the children experience occluder removal successfully and defect correction with satisfactory outcome.All cases got cardiac resuscitation automatically and detached from cardiopulmonary bypass(CPB) successfully after aortic unclamping under open heart operation.Among the 10 patients,9 cases survived with excellent results,1 case died of renal failure and multiple organs failure.Conclusion:Though interventional therapies are minor invasive and efficient for patients with PDA、ASD and VSD,there are also a certain amount of surgical risk and possibility of severe complications.Proper and timely surgical treatment is an efficient approach to correct cardiac defects and avoid deterioration of heart function.