经导管同期介入治疗儿童复合型先天性心脏病8例分析及随访

Analysis and follow up study on 8 children with combined congenital heart disease treated with simultaneous transcatheter therapy

摘要:

目的：儿童先天性心脏病(congenital heart disease,CHD)复合畸形(复合型CHD)既往外科手术是唯一的治疗方法，随着介入治疗技术的日渐成熟和新型封堵器械的不断出现，经导管同期介入治疗儿童复合型CHD引起人们的关注，目前，国内外报道尚不多。该研究对儿童复合型CHD经导管介入治疗的方法及疗效进行探讨。方法：应用经导管介入治疗方法同期封堵治疗8例儿童复合型CHD，其中男4例、女4例，平均年龄(6.1±2.9)岁，其中房间隔缺损(ASD)伴室间隔缺损(VSD)、动脉导管未闭(PDA)1例，ASD伴PDA、肺动脉瓣狭窄(PS)1例，ASD伴PDA 1例，卵原孔未闭(PFO)伴PS 1例，ASD伴PS 4例。经导管介入治疗的原则是:ASD伴VSD、PDA者，先行VSD封堵术，再行PDA封堵术，最后行ASD封堵术;ASD伴PDA、PS者，先行经皮球囊肺动脉瓣成形术(PBPV)纠正PS，再行PDA封堵术，最后行ASD封堵术；PFO伴PS和ASD伴PS者，先行PBPV纠正PS，其次行PFO或ASD封堵术。结果：8例复合型CHD均1次治疗成功，术中未发生任何严重并发症。术后即刻超声和造影检测显示VSD、ASD及PDA均无残余分流，6例合并PS者，跨肺动脉瓣压差由术前的75.3±15.6 mmHg下降至术后的14.0±5.6 mmHg，经3.4±1.2年随访证实无残余分流，跨瓣压差均在通常标准良好的范围内，无任何并发症发生。结论：经导管介入治疗儿童复合型CHD技术要求较单纯型CHD相对高，宜遵循先难后易、后期操作不影响前面治疗的原则，规范操作，可获良好的治疗效果。

Abstract:

OBJECTIVE: Interventional treatment for childhood combined congenital heart disease (CHD) has developed very quickly and more new types of occluders have emerged in recent years. The aim of this study is to investigate the efficiency and safety of interventional treatment for combined CHD in children. METHODS: Eight children with combined CHD (4 boys and 4 girls), aged 6.1±2.9 years, underwent simultaneous transcatheter therapy. Of the 8 children with CHD, 1 case had atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA), 1 case had ASD, PDA and pulmonary stenosis (PS), 1 case had ASD and PDA, 1 case had patent foramen ovale (PFO) and PS, and 4 cases had ASD and PS. The methods of transcatheter intervention for these patients were as follows: in patients with ASD,VSD and PDA, the occlusion of VSD was performed first, followed by PDA and ASD occlusions; in patients with ASD, PDA and PS, the occlusion of percutaneous balloon pulmonary valvuloplasty (PBPV) was performed first, followed by PDA and ASD occlusions; in patients with PFO and PS, the occlusion of PBPV was performed first, and PFO occlusion followed; in patients with ASD and PS, the occlusion of PBPV was performed first, and ASD occlusion followed. RESULTS: The intervention operation was successfully performed in all of the 8 patients. No serious adverse events occurred during the operation. No residual shunt was found and all the occlusion devices were in the suitable sites shown by transthoracic echocardiography (TTE) and X-ray right after the operation. In the 6 patients with PS, the systolic pressure across the pulmonary valve decreased from 75.3±15.6 mmHg (before operation) to 14.0±5.6 mmHg after operation (P<0.05).A 3.4±1.2 years follow-up demonstrated that no residual shunt occurred and gradients across valve or coarctation sites were within the limit of satisfactory results. No complications were observed during the follow-up. CONCLUSIONS: Transcatheter interventional therapy for childhood combined CHD can obtain satisfactory results by proper procedures.