小儿先天性心脏病介入治疗302例回顾分析

目的总结先天性心脏病患者介入治疗疗效、并发症情况及预防措施。方法回顾性分析302例行介入治疗的先天性心脏病患儿的临床资料,着重分析治疗疗效及总结并发症的处理经验。本组共302例患儿,男125例,女177例,年龄3个月～14岁,中位年龄4.4岁,体质量(12.8±6.7)kg。其中动脉导管未闭(patent ductus arteriosus,PDA)组183例、房间隔缺损(atrial septal defect,ASD)组69例、室间隔缺损(ventricular septal defect,VSD)组50例,分别行PDA、ASD、VSD堵闭术,术后半年内每个月随访心电图及超声心动图检查1次,半年后每6～12个月复查心电图及超声心动图检查1次。结果 PDA组、ASD组、VSD组的成功封堵率分别为99.4%(182/183),100%(69/69),98%(49/50)。各组术后并发症发生率(术后72h内)分别为2.2%(4/183),4.3%(3/69),10%(5/50)。PDA组183例患儿3例存在残余分流,1例出现溶血;ASD组69例患儿2例存在少量残余分流,1例出现暂时性Ⅱ度房室传导阻滞;VSD组50例患儿1例存在残余分流,1例出现Ⅲ度房室传导阻滞,3例出现完全性右束支传导阻滞。在6个月～3年的随访中,PDA组仅1例有微量残余分流,2例心脏扩大;ASD组无残余分流,Ⅱ度房室传导阻滞转为Ⅰ度房室传导阻滞;VSD组1例有少量残余分流,1例持续存在完全性左束支传导阻滞。结论 PDA及ASD封堵技术成熟,手术效果好,并发症发生率低。VSD封堵术后早期心律失常(术后5d左右)发生率较高,术后持续监测患者心电图的变化非常重要。

Retrospective analysis of transcatheter closure of congenital heart disease in 302 cases

Objectives To analyze the effects and complications during and after the transcatheter closure of congenital heart disease in 302 cases.Methods We retrospectively analyzed the data of 302 cases [125 males and 177 females,age from 1 month to 14 years],including 183 cases with patent ductus arteriosus （PDA）,69 with atrial septal defect （ASD） and 50 with ventricular septal defect （VSD）,underwent the transcatheter closure and were followed-up for 6 months to 3 years after the procedure.We focused on curative effect and treatment of complication.Results The successful rate of transcatheter closure was 99.4%（182 / 183） for PDA,100% （69 / 69） for ASD and 98%（49 / 50） for VSD.The complication morbidity after the procedure in 72 hours was 2.2% （4 / 183,residual shunts in 3 cases,hemolysis in 1 case） in PDA group,4.3%（3 / 69,residual shunts in 2 cases,Ⅱ° atrioventricular block in 1 case） in ASD group and 10%（5 / 50,residual shunts in 1 cases,Ⅲ° atrioventricular block in 1 case,complete left bundle branch block in 3 cases） in VSD group,respectively.During the 6 months to 3 years follow-up,trace residual shunts were found in 1 cases of PDA group.Ⅰ°atrioventricular block presented in 1 case of ASD group.Complete left bundle branch block was persisting in 1 case of VSD group.Conclusions In our study the transcatheter closure of PDA and ASD were safe and effective.The incidence rate of arrhythmia after the procedure in group VSD could be found higer than those of group PDA and ASD.It is important to monitor the patients with electrocardiogram continuously after the VSD procedure.