食道超声心动图引导下经胸小切口行肺动脉瓣球囊扩张术治疗婴幼儿肺动脉瓣狭窄

目的：总结10例肺动脉瓣狭窄婴幼儿在食道超声心动图(transesophageal echocardiography，TEE)引导下，经胸小切口行肺动脉瓣球囊扩张术(简称杂交手术)的疗效。方法：2009年9月至2015年12月中南大学湘雅二医院共收治10例肺动脉瓣狭窄婴幼儿，其中男6例，女4例；年龄0.7~42(14.8±15.8)个月，其中新生儿2例；合并房间隔缺损2例，卵圆孔未闭6例，动脉导管未闭1例，肌部室间隔缺损2例，永存左上腔静脉1例，三尖瓣反流5例，均在TEE引导下接受杂交手术治疗。结果：术后所有患儿均入重症监护室继续治疗，呼吸机辅助 0.5~41(6.8±12.3) h。监护室停留时间2~85(31.1±22.8) h，住院时间6~20(11.4±5.1) d。术后肺动脉跨瓣压差降至16~45(31.1±9.8) mmHg，较术前明显降低(P<0.001) 。全组无住院死亡，所有患儿术后恢复良好，顺利出院。结论：在TEE引导下行杂交手术治疗婴幼儿肺动脉瓣狭窄是一种安全、疗效优良的治疗策略。

Hybrid procedure for infants/children treatment with pulmonary stenosis under transesophageal echocardiographic guidance

Objective: To investigate the outcomes of hybrid procedure in treating 10 infants/children with pulmonary stenosis under transesophageal echocardiographic guidance.Methods: Between September, 2009 and December, 2015, 10 infants/children underwent hybrid procedure of transthoracic balloon pulmonary valvuloplasty for pulmonary stenosis in the Second Xiangya Hospital, Central South University. The age, height and weight at the time of admission were 0.7-42 (14.8±15.8) months, 53-97 (74.8±16.3) cm, and 4-15.5 (9.3±4.1) kg, respectively. Atrial septal defect, patent foramen ovale, patent ductus arteriosus, muscular ventricular septal defect, persistent left superior vena cava and tricuspid regurgitation were found in 2, 6, 1, 2, 1 and 5 cases, respectively.Results: After the operation, all patients were sent into ICU. The mean duration mechanical ventilation, ICU stay and hospitalization were 0.5-41(6.8±12.3) h, 2-85 (31.1±22.8) h, and 6-20 (11.4±5.1) d, respectively. Postoperative transvalvular pressure gradient reduced to 16-45 (31.1±9.8) mmHg, which was decreased significantly compared with that in preoperative (P<0.001). There was no death during hospitalization and follow-up.Conclusion: Hybrid procedure of transthoracic balloon pulmonary valvuloplasty for pulmonary stenosis under transesophageal echocardiographic guidance is a safe and effective treatment.