复杂先天性心脏病外科手术后残余心血管病变的介入治疗

目的 总结广东省心血管病研究所心儿科11年来进行的复杂先天性心脏病外科手术后残余病变的介入治疗病例的经验.方法 全组共42例患者,男30例,女12例,年龄5个月～30岁,体重7～46(17.9±9.1)kg.其中17例行体肺较大侧支血管栓塞术,15例行室间隔补片留孔或残余室间隔缺损、房间隔缺损的封堵术,12例行术后血管吻合口狭窄或分支肺动脉狭窄的球囊成形术与支架置入术.结果 17例行体肺较大侧支血管栓塞术的患者,共栓塞23支侧支血管,术后超声心动图随诊均无残余分流.1例死于多器官功能衰竭,其余患者均康复出院.15例行室间隔补片留孔或残余室间隔缺损、房间隔缺损的封堵术患者,均一次封堵成功,1例心室水平有少量残余分流,其余病例无残余分流,未出现三度房室传导阻滞等严重心律失常.12例行术后血管吻合口狭窄或分支肺动脉狭窄的球囊成形术与支架置入术患者,原狭窄处压力阶差均有不同程度下降[介入前为(59.3±15.1)mm Hg(1 mm Hg=0.133 kPa),介入后为(16.8±10.7)mm Hg,P＜0.001];置入支架后血流通畅,未见血栓形成.螺旋CT显示主动脉缩窄扩张处无夹层形成.结论 复杂先天性心脏病外科手术后残余病变行介入治疗效果良好,避免了再次开胸手术的创伤,扩大了手术适应证范围,降低了手术风险.

Interventional catheterization management for patients with postoperative residual cardiovascular malformations

Objective To evaluate the efficacy of interventional therapy for complex congenital heart defects patients with un-repaired or postoperative residual lesions.Methods Between March 1998 and April 2009,42 patients (12 females),mean age 6 years (5 months to 30 years) received interventional therapy,17 cases underwent occlusion of major acrto-pulmunary collateral arteries (MAPCAs),15 underwent device closure of residual ventricular or atrial septal shunting,12 underwent balloon angioplasty (n = 10) and stenting (n = 2) for stenosis of the anastomosis of vessels or branched pulmonary arteries.Results Twenty-three MAPCAs were performed in 17 patients without residual shunting.One patient died of multiple organ failure after intervention therapy and the remaining patients discharged without complication,successful device closure was performed in 15 patients and there was minimal residual shunting in 1 patient.There were no severe arrhythmias such as complete atrio-ventricular block during and post procedure.Exercise capacities were significantly improved in 12 patients underwent balloon angioplasty or stenting.Pressure gradients were significantly decreased and there was no aneurysmal or thromboembolic formation post procedure.Conclusions Interventional therapy is a safe and effective therapy option for treating complex congenital heart defects patients with un-repaired or postoperative residual lesions.