先天性心脏病外科术后残余病变的介入治疗

摘要

目的 探讨先天性心脏病(先心病)外科术后残余病变介入治疗的可行性.方法 1995年2月 - 2010年12月收治98例先心病外科术后残余病变患儿,年龄9个月～ 16岁,平均(5.5 ± 3.8)岁.对有先心病手术残余漏患儿选择不同封堵器封堵治疗,对有血管狭窄的患儿做球囊扩张或支架植入治疗.结果 70例先心病手术残余漏患儿选择封堵器成功封堵.15例肺动脉分支狭窄者,12例选择NuMED CP覆膜支架植入,左、右肺动脉压力差(ΔP)分别降为4和5 mmHg,另3例因年龄小选择球囊扩张,但术后ΔP仅部分下降10 ～ 15 mmHg左右.6例主动脉残余局限性狭窄,其中5例球囊扩张,1例无效,4例ΔP下降至(19 ± 6.7)mmHg;另1例,用NuMED CP支架植入后ΔP仅3 mmHg.其他血管狭窄者选球囊扩张,ΔP均降至正常范围.结论 对于部分先心病外科术后残余病变,可以通过介入治疗完成,避免了再次开胸手术.%Objective To explore the feasibility of interventional management for the post-operative residual lesions in congenital heart diseases. Methods Between February 1995 and December 2010, 98 children aged 9 months to 16 years (mean 5.5 ± 3.8 years) with post-operative residual lesions underwent interventional management,transcatheter embolization, balloon dilatation, or stent implantation. Results In 70 cases with residual shunts, all cases were occluded by transcatheter embolization successfully. In 15 cases with peripheral pulmonary stenosis, CP stents were placed in 12 cases with the pressure gradients of right and left pulmonary arteries dropped to 4 mmHg and 5 mmHg; another 3 cases underwent balloon dilatation due to young age with the pressure gradients dropped only by 10-15 mmHg. In 6 cases with residual aortic obstructions, balloon angioplasty were undergone in 5 cases, one of which was failed and 4 of which had pressure gradient dropped to 19 ± 6.7 mmHg; another patient underwent Endovascular CP stent im plantation and the pressure gradient were down to 3 mmHg. Other patients with angiostegnosis were performed balloon dilations and the pressure gradients wernt down to normal. Conclusions Some of post-operative residual lesions can be treated by interventional management.