先天性心脏病介入治疗后封堵器移位的急诊外科治疗

目的 探讨先天性心脏病（先心病）介入治疗后封堵器移位的原因以及急诊外科治疗的必要性和方法。方法 5例先心病病儿在接受介入治疗术后的数分钟到数天内封堵器部分移位或完全脱落，其中2例动脉导管未闭病儿封堵器分别脱落至左、右肺动脉开口处，2例房间隔缺损病儿封堵器部分移位造成残余分流，1例室间隔缺损病儿封堵器部分移位，封堵器尖端将三尖瓣前瓣腱索割断造成三尖瓣中到重度反流。5例在封堵器移位当日到1个月内在体外循环下急诊行封堵器取出术和先心病纠治术。结果 手术效果满意，5例病儿均未出现重要脏器功能损害，心功能恢复至Ⅰ级。结论 封堵器移位是先心病介入治疗后较严重的并发症；为防止和避免封堵器移位应严格掌握介入治疗术的指征和选择尺寸合适的封堵器；介入治疗术后早期应加强各项心脏专科检查和监测，一旦发现封堵器移位应紧急手术以避免病情恶化；只要处理及时，手术效果满意，心功能恢复良好。

Emergent surgical treatment of occluder displacement after interventional treatment with congenital heart disease

Objective To approach the cause of occluder displaeenent after intervenfional treatment with congenital heart disease and to evaluate the necessity and method of eanergent surgical treatment. Methods In 5 cases of congenital heart disease, the occluder was partially or totally dislocated from few minutes to few days after intervenfional treatment, including occluder dislocated to the orifice of left or fight pulmonary artery in 2 cases of patent ductus arteriasus, occluder partial displacement resulted in residual shunt in 2 cases of atrial septal dofect, occluder partial displacement severed the resulted in moderate to severe tricuspid valve regurgitation. All of the 5 patients underwent surgical treatment including reraoval of displaced occluder and congenital heart disease repair on cardiopulmonary bypass on the save day of intervenfional treatment or one month after. Results The result of surgical treatment was satisfying. All patients recovered, heart function was in NYHA class I . Conchusion Occluder displacement is a severe complication after interventional treatment with congenital heart disease. Once the occluder was found dislocated, a more aggressive strategy with emergent earlier surgical treatment is advocated before deterioration of heart function. Indication for intervenfional treatment should be strict and the size of occluder should be chosen conecfly to avoid the displacement. The result of timely and proper surgical treatment is satisfactory.