论文部分内容阅读
【目的】研究复合型先天性心脏病同期介入治疗的可行性、方法及疗效。【方法】2004年1月至2006年7月本院先心病介入治疗的患者共447例,其中复合型先天性心脏病患者12例,男5例,女7例,房间隔缺损(ASD)合并室间隔缺损(VSD)5例,ASD合并动脉导管未闭(PDA)3例、ASD合并肺动脉瓣狭窄(PS)2例,ASD合并二尖瓣狭窄(Lutembacher综合征)1例,VSD合并PDA 1例。经导管介入治疗的顺序:先纠正瓣膜狭窄行瓣膜球囊扩张术,其次VSD封堵术,再次PDA封堵术,最后行ASD封堵术。术后1周、1个月、6个月分别行经胸超声心动图、X线检查及心电图评价治疗效果。【结果】12例复合型先天性心脏病患者均一次性治疗成功。术中未发生任何重要并发症。术后即刻经胸超声心动图和造影示ASD、VSD、PDA所有封堵器位置良好,无残余分流。2例合并PS者,跨肺动脉瓣压差由术前48 mmHg、54 mmHg下降到术后7 mm-Hg1、0 mmHg。1例Lutembacher综合征患者,超声心动图测量二尖瓣瓣口面积分别由二尖瓣球囊扩张术前1.0 cm2增加到术后2.1 cm2。术后1周、1个月、6个月经胸超声心动图检查示所有患者各水平分流均消失,扩大的房室内径进行性缩小,所有封堵器位置固定良好,无移位及脱落;X线检查示肺血均明显减少,心脏扩大均明显恢复;心电图检查无房室传导阻滞及左右束支阻滞。【结论】复合型先天性心脏病管同期介入治疗只要指征掌握恰当,治疗策略合理,操作规范,是可行、安全的,并可获得良好的治疗效果。
【Objective】 To investigate the feasibility, method and efficacy of concurrent interventional therapy for complex congenital heart disease. 【Methods】 From January 2004 to July 2006, 447 cases of interventional treatment of congenital heart disease in our hospital, including 12 cases of complex congenital heart disease, 5 males and 7 females, atrial septal defect (ASD) merger 5 cases of ventricular septal defect (VSD), 3 cases of ASD combined with patent ductus arteriosus (PDA), 2 cases of ASD combined with pulmonary stenosis (PS), 1 case of ASD combined with mitral stenosis (Lutembacher syndrome), 1 case of VSD combined with PDA 1 example. Transcatheter interventional treatment of the order: the first to correct valvular stenosis valvular balloon dilatation, followed by VSD occlusion, PDA occlusion again, and finally ASD occlusion. One week, one month and six months after operation, transthoracic echocardiography, X-ray examination and electrocardiogram were used to evaluate the therapeutic effect. 【Results】 All the 12 patients with complex congenital heart disease were treated successfully. No major complications during surgery. Immediate postoperative transthoracic echocardiography and angiography showed ASD, VSD, PDA all occluders in good position, no residual shunt. In 2 patients with PS, the pressure difference across the pulmonary valve decreased from 48 mmHg and 54 mmHg to 7 mm-Hg1,0 mmHg after operation. In 1 patient with Lutembacher’s syndrome, the mitral valve orifice area measured by echocardiography increased from 1.0 cm2 before balloon dilation to 2.1 cm2 after balloon dilation. The transthoracic echocardiography at 1 week, 1 month and 6 months after operation showed that all the patients’ level of shunt disappeared, and the size of the enlarged AV chamber decreased progressively. All the occluders were well fixed with no displacement and shedding. X Line examination showed significantly reduced lung blood, heart enlargement were significantly restored; ECG without atrioventricular block and left bundle branch block. 【Conclusions】 Interventional therapy of concomitant congenital heart disease complicated with congenital heart disease is feasible and safe as long as the indications are appropriate, the treatment strategy is reasonable, and the treatment effect is good.