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目的:探讨小儿复合先天性心脏病(先心病)经导管介入治疗的策略及评价其疗效和安全性。方法:55例复合先心病患儿,先心病类型包括:肺动脉瓣狭窄(PS)合并房间隔缺损(ASD);PS合并动脉导管未闭(PDA);PS合并室间隔缺损(VSD);ASD合并PDA;ASD合并VSD;PDA合并VSD;室间隔完整的肺动脉闭锁(PA/IVS)合并PDA和卵圆孔未闭(PFO);主动脉瓣狭窄合并PDA;PDA合并肺隔离症。分别行射频打孔,经皮球囊肺动脉瓣成形术(PBPV),经皮球囊主动脉瓣成形术(PBAV),VSD封堵术,PDA封堵术,ASD封堵术,侧支血管堵塞术。结果:55例患儿经导管介入治疗均获得成功,术中未发生严重并发症,55例行介入堵闭均未见残余分流,堵闭器位置良好;30例行PBPV术,跨肺动脉瓣压差由术前平均(63.4±36.3)mmHg(1mmHg=0.133kPa),下降到术后平均(18.1±13.0)mmHg(P<0.01);1例行PBAV术,跨主动脉瓣压差由术前90mmHg下降到术后50mmHg;3例PA/IVS行射频打孔和PBPV术,术后肺动脉瓣开放满意,血氧饱和度维持良好。结论:复合先心病经导管介入治疗疗效确切、安全有效,但手术操作难度大,技术要求高,应该在较大心血管医院开展,并由有较丰富导管操作经验的医师施行。
Objective: To explore the strategy of transcatheter interventional treatment of children complicated with congenital heart disease (CHD) and evaluate its curative effect and safety. Methods: Fifty-five children with congenital heart disease (CHD) were enrolled in this study. The types of CHD included pulmonary stenosis (PS) with atrial septal defect (ASD), PS with patent ductus arteriosus (PDA), PS with ventricular septal defect (VSD) PDA; ASD with VSD; PDA with VSD; Complete interventricular septum pulmonary atresia (PA / IVS) with PDA and patent foramen ovale (PFO); Aortic stenosis with PDA; PDA with pulmonary sequestration. Percutaneous balloon pulmonary valvuloplasty (PBPV), percutaneous balloon aortic valvuloplasty (PBAV), VSD occlusion, PDA occlusion, ASD occlusion, collateral vessel blockage Surgery. Results: All the 55 cases were successfully treated by catheterization. There were no serious complications in operation. No residual shunt was found in 55 cases, and the position of the blocker was good. PBPV was performed in 30 cases and pulmonary valve pressure The difference was preoperatively (63.4 ± 36.3) mmHg (1 mmHg = 0.133 kPa) and decreased to an average of 18.1 ± 13.0 mmHg after operation (P <0.01). One patient underwent PBAV. The transaortic pressure difference 90mmHg decreased to 50mmHg after operation. Three cases of PA / IVS underwent RFP and PBPV. The pulmonary valve was satisfactorily opened and the oxygen saturation was maintained well. CONCLUSION: Catheterization of compound CHD is effective, safe and effective. However, the operation is difficult and requires high technical requirements. It should be carried out in a large cardiovascular hospital and administered by a physician with extensive experience in catheter management.