同期介入治疗先天性心脏病复合畸形30例的疗效观察

目的探讨经导管同期介入治疗先天性心脏病复合畸形的方法及疗效。方法先心病复合畸形30例，男性14例，女性16例，平均年龄（17．9±13．5）岁，平均体重（38．8±22．0）kg。复合类型为：房间隔缺损（ASD）并动脉导管未闭（PDA）7例，ASD并室间隔缺损（VSD）10例，ASD并肺动脉瓣狭窄（PS）6例，VSD并PDA5例，PDA并PS1例，VSD并PDA并ASD1例。经导管治疗原则：先行瓣膜球囊扩张术纠正瓣膜狭窄，其次行VSD封堵术，再行PDA封堵术，最后行ASD封堵术，可根据具体情况相应调整。术后2d、1个月、3个月、6个月、1年复查超声心动图及心电图。结果30例复合型先天性心脏病患者均一次治疗成功。7例合并PS患者，跨肺动脉瓣压差由术前（46．1±15．1）mmHg下降到术后（17．6±3．8）mmHg（P〈0．01），1例室间隔缺损术后心电图提示不完全右束支传导阻滞，1例室间隔缺损术后心电图提示完全右束支传导阻滞，1例室间隔缺损术后心电图提示不完全左束支传导阻滞，给予地塞米松治疗后，心电图复查正常。1例VSD并ASD患者术前心电图提示双束支传导阻滞，术后观察10d仍存在，给予置人心脏永久起搏器。2例VSD并PDA患者术后超声心动图提示心室水平微量分流，6个月时随访分流消失。所有患者随访无不良并发症发生。结论对先天性心脏病复合畸形，严格掌握介人治疗适应证，选择正确的操作顺序和方法，可以取得良好的效果。

Clinical outcome of transcatheter intervention therapy in 30 patients with combined congenital cardiac deformities in the same session

Objective To probe the safety and clinical results of percutaneous transcatheter intervention therapy in patients with combined congenital heart deformities in the same session. Methods Thirty patients（ 14 males and 16 females） with combined congenital heart deformities underwent simultaneous transcatheter intervention therapy,including 7 patients with atrial septal defect （ASD） and patent ductus arteriosus （PDA）, 10 patients with ASD and ventricular septal defect （VSD）, 6 patients with ASD and pulmonary stenosis （PS）, 5 patients with ASD and PDA, 1 patient with PDA and PS, 1 patient with VSD,PDA and ASD. Their mean age was （17.9＋13.5）years. Their mean weight was （38.8＋22.0） Kg. They underwent transcatheter therapy simultaneously with the sequential algorithm as balloon pulmonary valvuloplasty at first, followed by the occlusion of VSD,then the occlusion of PDA, then ASD, which can be adjusted depending on the circumstances.Follow-up with electrocardiogram （ECG） and transthoracie echocardiography （TTE） was undertaken 2d,lm,3m,6m and 12 m after the procedures. Results 30 patients were treated successfully. In the 7 patients complicated with PS,the systolic pressure gradient across the pulmonary valve decreased from （46.1＋15.1）mm Hg to （17.6＋3.8）mm Hg and the difference was significant （P〈 0.01 ）.1 patient showed incomplete right bundle branch block,1 patient showed complete right bundle branch block and 1 patient showed incomplete left bundle branch block after intervention therapy,and ECG showed normal after treatment with dexamethasone.1 patient with VSD and ASD, preoperative and 10 days after the procedure whose ECG showed Bifascicular block.The patient was given a permanent implanted cardiac pacemaker.Among two pa- tients with VSD,a slight crevice shunt was detected after the procedure by TYE,they were detected disappearance of the crevice shunt by TFE at 6 months after the procedure.No patient encountered complications during follow-up. Conclusion Simultaneous transcatheter therapy of combined congenital heart deformities can obtain satisfactory ef- fect by strict indication control and procedure manipulations.