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目的:研究先天性心脏病复合畸形经导管介入治疗策略并评价其疗效。方法:先天性心脏病复合畸形57例,复合类型为:膜部室间隔缺损(VSD)并房间隔缺损(ASD)21例,VSD并动脉导管未闭(PDA)4例,ASD并PDA8例,ASD并肺动脉瓣狭窄(PS)22例,VSD并PS2例。复合畸形同期介入治疗顺序依次为:PS球囊扩张术,VSD封堵术,PDA封堵术,最后行ASD封堵术。结果:57例患者中,除1例因PDA过小,导丝无法通过未闭导管,在VSD成功封堵后放弃PDA封堵。56例患者同期经导管介入治疗均获成功,术中未发生任何重要并发症。术后造影及超声检查VSD、ASD及PDA均无残余分流,封堵器固定好。并发PS的24例患者,跨肺动脉瓣压差由术前(96.0±30.0)mmHg(1mmHg=0.133kPa)下降到术后平均(15.6±3.3)mmHg(P<0.01)。术后3d、1个月、6个月及1年分别行经胸超声心动图、心电图、X线检查,全部患者无残余分流,封堵器位置固定良好,跨瓣压差均在正常范围内,无任何并发症发生。结论:先天性心脏病复合畸形经导管介入治疗安全有效,值得推广。
Objective: To study the catheter interventional treatment strategy for congenital heart disease complicated with deformity and to evaluate its curative effect. Methods: A total of 57 cases of congenital heart disease complicated with deformity were included in this study. The complex types were as follows: 21 cases with membranous ventricular septal defect (VSD) and atrial septal defect (ASD), 4 cases with VSD and patent ductus arteriosus (PDA), 8 cases with ASD and PDA, And pulmonary valve stenosis (PS) in 22 cases, VSD and PS2 cases. The sequence of interventional treatment for composite deformity was PS balloon dilation, VSD occlusion, PDA occlusion, and finally ASD occlusion. Results: Of the 57 patients, except for 1 case, the PDA was unable to pass through the patent ductus arteriosus and PDA was blocked after VSD was successfully blocked. Fifty-six patients were successfully treated by catheterization during the same period. No major complications occurred during the operation. Postoperative radiography and ultrasonography VSD, ASD and PDA no residual shunt, occluder fixed. In the 24 patients with PS, the pressure drop across the pulmonary valve decreased from (96.0 ± 30.0) mmHg (1mmHg = 0.133kPa) to (15.6 ± 3.3) mmHg after operation (P <0.01). All patients underwent transthoracic echocardiography, electrocardiogram and X-ray examination at 3d, 1 month, 6 months and 1 year after operation. No residual shunt was found in all patients. The position of occluder was well fixed, and the transvalvular pressure was within the normal range. No complications occurred. Conclusion: Congenital heart disease complex deformity by catheter intervention safe and effective, it is worth promoting.