先天性心脏病复合畸形介入治疗19例临床分析

摘要

目的：探讨先天性心脏病（CHD）复合畸形介入治疗的疗效和安全性。方法CHD复合畸形患者19例，男11例，女8例，年龄5～36（15．2±10．7）岁，体质量25．6～55．8（32．2±26．1）kg；其中房间隔缺损（ASD）合并动脉导管未闭（PDA）5例，ASD合并肺动脉瓣狭窄（PS）6例，ASD合并室间隔缺损（VSD）3例，VSD合并PS 3例，PDA合并PS 1例，PDA合并B型预激综合征1例。介入治疗顺序为：PS球囊扩张术、VSD封堵术、PDA封堵术、ASD封堵术；PDA合并预激综合征先行射频消融治疗，再行PDA封堵术。结果19例患者均一次性介入治疗成功，术中无严重并发症发生，术后造影和心脏彩超证实无明显残余分流，封堵器固定良好。10例合并PS患者的跨肺动脉瓣压差由术前的（50．6±17．2） mm Hg降至术后的（21．2±9．5） mm Hg（ t ＝6．28， P ＜0．01）。 ASD合并其他畸形患者14例，均采用ASD封堵器，封堵器直径平均为（20．6±10．5）mm；PDA合并其他畸形患者6例，2例选用弹簧圈封堵，其余4例患者选用PDA封堵器，平均直径为（7．1±2．5）mm；VSD合并其他畸形患者6例，膜周部4例，并膜部瘤形成2例，均采用对称型VSD封堵器，封堵器直径平均为（9．5±3．2）mm。结论严格掌握适应证，制定合理的操作策略，CHD复合畸形介入治疗的疗效肯定，安全可行。%Objective To investigate the efficiency and safety of interventional therapy for treatment of malformation in congenital heart disease ( CHD) .Methods There were 19 cases of CHD complex malformation, male was 11 cases, fe-male was 8 cases, age ranged from 5 to 36 (15.2 ±10.7) years old, body weight ranged from 25.6 to 55.8 (32.2 ±26.1) kg;CHD including atrial septal defect ( ASD) combined with patent ductus arteriosus ( PDA) in 5 cases, ASD with pulmona-ry valve stenosis ( PS) in 6 cases, ASD with ventricular septal defect ( VSD) in 3 cases, 3 cases of VSD complicated with PS, 1 cases of PDA complicated with PS, 1 cases of PDA with type B pre-excitation syndrome.Interventional therapy in the order of:PS balloon dilation, VSD closure, PDA closure, ASD closure; PDA with pre-excitation syndrome was first with radiofre-quencyablationtherapy,thenforPDAclosure.Results 19patientswerereceived1timesuccessfulinterventionaltreatment, no serious complications occurred during the operation, postoperative angiography and cardiac ultrasound demonstrated no ob-vious residual shunt were occurred, and the occluder fixed well.In 10 cases of patients with PS, the systolic pressure across pulmonary valve were decreased from (50.6 ±17.2) mm Hg preoperative to (21.2 ±9.5) mm Hg postoperative ( t =6.28, P <0.01).In 14 cases of ASD patients complicated with other malformations, all of them received ASD occluder therapy, occluder diameter with averaged of (20.6 ±10.5) mm;in 6 cases of PDA patients complicated with other malformations, 2 cases received coil occlusion, the other 4 patients received with PDA septal occluder, average diameter of (7.1 ±2.5) mm;VSD combined with other deformities in 6 cases, 4 cases in the membranous, and combined with membranous aneurysm for-mation in 2 cases, all of them received the symmetric VSD closure, the occluder diameter with averaged of (9.5 ±3.2) mm. Conclusion Strict indications with reasonable operation strategy, the interventional treatment of CHD complex malformation revealed curative effects with safety and feasible.