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为探讨经导管射频瓣膜打孔并球囊扩张治疗婴儿室间隔完整的肺动脉瓣闭锁(PA-IVS)的有效性和安全性,对4例11个月内的患儿在全麻下作右心室造影确诊后经导管射频打孔并球囊扩张术治疗。射频瓣膜打孔能量5~8W,持续时间2~5s,一般2次;预扩球囊(3mm×5mm)~(5mm×20mm),6~14atm;肺动脉瓣扩张球囊(10mm×30mm)~(11mm×30mm),有效扩张1~2次。手术持续时间120~150min,X线暴露时间25·4~43·9min。4例全部技术成功,1例新生儿发生心脏穿孔,其他3例无任何并发症。早期死亡1例,存活3例均达到双室循环。随访2~8(平均4·3)个月,2例可择期封堵动脉导管未闭,1例需外科解除右室流出道梗阻。结论:经导管射频瓣膜打孔并球囊扩张术治疗PA-IVS要严格掌握适应证,规范操作,对某些病例可代替外科开胸手术治疗。
To investigate the effectiveness and safety of transcatheter RF-guided perforation and balloon dilatation in the treatment of complete pulmonary valve atherosclerosis (PA-IVS) in infants, 4 cases of 11-month-old children underwent general anesthesia with right ventricle Radiographically confirmed by catheter catheterization and balloon dilation puncture. RF valve puncture energy of 5 ~ 8W, duration of 2 ~ 5s, usually 2 times; pre-expansion balloon (3mm × 5mm) ~ (5mm × 20mm), 6 ~ 14atm; pulmonary valve dilatation balloon (10mm × 30mm) (11mm × 30mm), effective expansion of 1 to 2 times. The duration of operation was 120 ~ 150min and the time of X-ray exposure was 25.4 ~ 43.9min. All 4 cases were successful, 1 case of neonatal cardiac perforation, the other 3 cases without any complications. 1 case of early death, 3 cases of survival have reached double-chamber circulation. Follow-up 2 to 8 (average 4.3) months, 2 cases of selective closure of patent ductus arteriosus, 1 case required surgical removal of right ventricular outflow tract obstruction. Conclusion: Transcatheter RF-guided perforation and balloon dilatation in the treatment of PA-IVS should strictly follow the indications and normative operation, and may replace the surgical thoracotomy in some cases.