摘要
目的探讨结合介入器械和实时影像学的术中'杂交'(hybrid)手术对复杂性先天性心脏病的治疗价值.方法2005年3月～10月,我院行hybrid手术治疗7例复杂性先天性心脏病.球囊扩张组3例均为室间隔完整型肺动脉闭锁(PAIVS)的新生儿.缺损封堵组4例,其中1例右冠状动脉异常起源于肺动脉合并房间隔缺损,1例右侧肺静脉异位引流合并房间隔缺损(ASD),2例多发室间隔缺损(VSD).正中进胸,在超声引导下经右室流出道置入球囊扩张管扩张肺动脉瓣或经右心房植入封堵器.多发室间隔缺损于体外循环下经三尖瓣植入封堵器.合并的其他心脏病变同期常规外科矫正.术后心脏超声随访.结果7例均顺利出院,无一例手术死亡.3例PAIVS术后中位住院时间10 d,余4例均在术后7 d出院.随访1～6个月,7例生长发育良好,人工体肺分流管通畅,未发现中度以上的肺动脉瓣再狭窄,ASD和多发VSD术后均未发现明显残余分流及封堵器移位,均无影响瓣膜功能等并发症发生.结论hybrid手术可以不采用体外循环,减少手术创伤,对于提高复杂性先天性心脏病的疗效具有重要的意义.
Objective To summarize the application of hybrid procedures for the management of complex congenital heart diseases （CCHD）. Methods Seven patients with CCHD underwent intraoperative hybrid procedures between March and October, 2005. The 7 patients were divided into two groups： the balloon valvuloplasty was performed in 3 neonates with pulmonary atresia with intact ventricular septum （ Balloon Group） and the device closure was conducted in 2 patients with multiple ventricular septum defect （VSD） , 1 patient with atrial septum defect （ASD） accompanying abnormal origin of pulmonary artery, and 1 patient with atrial septum defect accompanying partially anomalus pulmonary vein connection （Closure Group）. The operation was performed through a median thoracotomy. Under the guidance of real - time echocardiography, the balloon was placed via the right ventricular outflow tract or the occluder was introduced via the right atrium. In patients with multiple VSD, the occluder was passed via the tricuspid valve approach for the closure of muscular VSD under cardiopulmonary bypass. Other associated heart diseases were treated simultaneously with conventional surgery. The patients were followed by echocardiography postoperatively. Results All the 7 patients were discharged from hospital smoothly. No surgery - related deaths occurred. The median postoperative hospital stay was 10 days in 3 patients with pulmonary atresia with intact ventricular septum, while the other 4 patients were dismissed at 7 days after operation. All the 7 patients were well - developed during follow - up observations for 1 - 6 months. The cavopulmonary anastomosis was found patent and no recurrence of moderate - to - severe pulmonary valve stenosis was observed. No residual shunt or occluder shift was found. No device - related complications occurred. Conclusions The hybrid procedure can avoid cardiopulmonary bypass and minimize surgical trauma, being an effective option for the management of complex congenital heart diseases.
出处
《中国微创外科杂志》
CSCD
2005年第12期976-977,共2页
Chinese Journal of Minimally Invasive Surgery
基金
国家科技部十五攻关项目资助(2004BA714B0)
关键词
复杂性先天性心脏病
介入治疗
心脏外科手术
Complex congenital heart disease
Catheter- based intervention
Cardiac surgical procedure
