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目的分析介入治疗复杂先天性心脏病(先心病)手术后残余心血管病变的效果,探讨先心病术后残余病变应用介入治疗的可行性。方法选取采取介入治疗的复杂先心病手术后残余心血管病变患者75例为研究对象,其中应用体肺较大侧支血管栓塞术((MAPCAS)治疗的患者共29例,应用封堵术治疗的患者共26例,应用球囊成形术或支架置入术治疗的患者共20例,回顾性总结患者的治疗效果。结果本组中应用MAPCAS栓塞术治疗的29例患者中,共有40支侧支血管发生栓塞,在治疗后经超声心动图检查均未发现残余分流,其中2例患者由于多器官功能衰竭而死亡,其余27例患者康复出院;采取封堵术治疗的26例患者,均一次性成功封堵,术后未见重度房室传导阻滞等严重并发症,仅发生2例心室水平少量残余分流。采取球囊成形术或支架置入术治疗的20例患者,狭窄处压力阶差显著降低,介入前狭窄处压力阶为(60.2±14.9)mmHg,介入治疗后狭窄处压力阶差显著降低,为(17.3±11.4)mmHg,介入治疗前后狭窄处压力阶差的差异有统计学意义(P<0.01);置入支架患者在治疗后血流通畅,未形成血栓,螺旋CT检查提示主动脉缩窄扩张处未形成夹层。结论介入治疗能够有效治疗复杂先心病手术后心血管残余病变,但在治疗中应严格把握治疗指征,根据病情制定适宜的介入治疗方案。
Objective To analyze the effect of interventional therapy on residual cardiovascular disease after complicated congenital heart disease (CHD) and to explore the feasibility of interventional treatment of residual disease after CHD. Methods Seventy-five patients with residual cardiovascular disease after interventional treatment of complicated congenital heart disease were enrolled in this study. Twenty-nine patients were treated with MAPCAS, and were treated with occlusion A total of 26 patients, the application of balloon angioplasty or stenting in patients with a total of 20 cases, retrospectively summarized the treatment of patients.Results In this group of MAPCAS embolization in 29 patients, a total of 40 side branches Vascular embolism, after treatment, no evidence of residual shunt by echocardiography, of which two patients died of multiple organ failure, the remaining 27 patients were discharged from hospital; the closure of the treatment of 26 patients were one-time Successfully blocked, no serious postoperative complications such as severe atrioventricular block, and only a small amount of ventricular shunt occurred in 2 cases.Twenty patients underwent balloon angioplasty or stenting, the pressure gradient at the stenosis (60.2 ± 14.9) mmHg before stenosis. The pressure gradient at the stenosis was significantly lower after interventional treatment (17.3 ± 11.4) mmHg, and there was a statistically significant difference in the pressure gradient between the two groups (P <0.01) .In the stent group, the blood flow was unobstructed after the treatment, no thrombus was formed, spiral CT examination showed no dissection in the aortic constriction.Conclusion Interventional therapy can effectively treat the residual cardiovascular diseases after complicated congenital heart disease , But in the treatment should strictly grasp the indications for treatment, according to the condition to develop appropriate interventional programs.