心脏外科手术与介入性心导管术镶嵌治疗小儿先天性心脏病

目的 报道23例介入性心导管术与心脏外科手术镶嵌治疗小儿先天性心脏病(CHD)的经验。方法外科术后镶嵌治疗：12例动脉导管未闭结扎术后残余分流及2例心脏术后留置室间隔缺损(VSD)的复杂CHD行经导管封堵术。2例法洛四联症(TOF)根治术后分支肺动脉狭窄分别行球囊血管成形术及支架置入术，1例肺动脉闭锁合并VSD根治术后出现体肺侧支血管(APCAs)破裂行介入栓塞止血术。外科术前介入治疗：5例室间隔完整的大血管转位(TCA)病例行大动脉调转术前行球囊房隔造口术(BAS)，1例有巨大APCAs的重症。TOF在根治术前予以侧支血管堵塞术。结果动脉导管未闭术后残余分流及复杂CHD残留VSD病例均封堵成功，分支肺动脉狭窄病例介入治疗后狭窄减轻或治愈；侧支血管破裂病例栓塞止血后出血停止。BAS病例介入术后低氧及酸中毒改善，大动脉调转术后3例治愈，2例死亡。TOF病例APCAs堵塞后成功行根治术。结论心脏外科手术与介入性心导管术镶嵌治疗是治疗小儿CHD术后残余分流及部分复杂疑难CHD的有效方法。

Cardiac surgical procedures and conjoined interventional catheterization performed in 23 children with congenital heart disease

Objective To summarize the experience of interventional catheterization conjoined with cardiac surgical procedures performed in 23 children with congenital heart disease(CHD). Methods 12 cases with residual patent ductus arteriosus after surgical ligation and 2 postoperative cases with severe cyanosis CHD with leftover ventricular septal defect (VSD) received transcatheter closure procedures. 2 children with branch pulmonary stenosis after total correction of tetralogy of Fallot (TOF) received angioplasty and stent placement, respectively. Another postoperative case with aortopulmonary collateral arteries (APCAs) angiorrhexis underwent transcatheter haemostasis. 6 cases underwent interventional catheterization in the preoperative period. 5 cases with transposition of great arteries (TGA) underwent balloon atrial septostomy (BAS) before artery switch procedure and 1 case of TOF underwent APCAs transcatheter occlusion before total correction. Results All cases with residual left to right shunts after surgery were occluded by transcatheter therapy. Interventional catheterization procedure relieved stenosis of branch pulmonary artery in postoperative case with TOF. Haemorrhage was stopped with embolization of ruptured APCAs. Hypoxia and acidosis improved after BAS therapy in 5 cases with TGA and intact ventricular septum and 3 survived from following artery switch procedure while 2 died. The APCAs was transcatheter occluded before TOF total correction. Conclusion Interventional catheterization therapy conjoined with cardiac surgical procedure was an effective and essential method in some postoperative CHD cases and in some of complex cyanosis CHD cases.