【摘要】 目的　研究复合型先天性心脏病经导管介入治疗策略并评价其疗效。方法　本文包括1997年 7月至 2 0 0 1年 10月共 8例适合经导管介入治疗的复合型先天性心脏病患儿 ,其中男 7例 ,女 1例 ,平均年龄 (5 0± 4 3)岁。复合类型为 :肺动脉瓣狭窄 (PS)伴动脉导管未闭 (PDA) 3例 ,房间隔缺损(ASD)伴PDA 2例 ,主动脉缩窄 (COA)伴主动脉瓣狭窄 (AS) 1例 ,COA伴PDA 2例。经导管介入治疗原则为 :PS伴PDA者 ,先行PS瓣膜成形术 ,然后堵塞PDA ;ASD伴PDA者 ,先后分别行PDA及ASD堵塞术 ;COA伴AS者 ,先行AS瓣膜成形术 ,然后再行COA血管成形术 ;COA伴PDA者 ,先行COA血管成形术 ,2个月以后再行PDA堵塞术 (PDA直径 3 5mm用AmplatzerPDA堵塞装置堵塞 ) ,或COA血管成形术与PDA堵塞术同时进行 (PDA直径 1 7mm用弹簧圈堵塞 )。小于 2 5mm的PDA用弹簧圈堵塞 ,大于等于 2 5mm的PDA用AmplatzerPDA堵塞装置堵塞。球囊 /瓣膜比 (或球囊 /缩窄段比 )、AmplatzerASD堵塞装置、AmplatzerPDA堵塞装置及弹簧圈大小的选择按常规。术后 1个月、3个月、6个月、1年 ,以后每年定期随访。结果　 8例复合型先天性心脏病患儿经导管介入治疗均获成功。术后即刻已堵塞之ASD及PDA均无残余分流 ,跨肺动脉瓣压差由术前的 (95 0± 34 6 )mmHg (1mmHg=更多还原

【Abstract】 Objective To investigate the tactics of interventional catheterization for combined congenital heart disease and evaluate its efficacy.Methods From July 1997 to October 2001, 8 patients (7 male,1female)underwent transcatheter intervention for combined congenital heart disease.Their mean age was 5.0±4.3 years.Types of the combination were as follows:PS and PDA,3 cases;ASD and PDA,2 cases;COA and AS,1 case;COA and PDA,2 case.Tactics of transcatheter intervention was:for PS and PDA,PBPV first,occlusion of PDA later;for ASD and PDA, occlusion of PDA first,ASD later;for COA and AS,PBAV first,dilation of COA later; for COA and PDA,dilation of COA first,occlusion of PDA 2 months later (for PDA 3.5 mm with Amplatzer PDA occluders),or dilation of COA and occlusion of PDA at the same time (for PDA 1.7 mm in diameter with coils ).PDAs of <2.5 mm in diameter were occluded with coils and those of ≥2.5 mm with Amplatzer PDA occluders.Ratios of balloon/valve or balloon/coarctated segment and size of Amplatzer PDA or ASD occluders and coils were sellected according to our routine. The patients were followed up for 1 month,3 months,6 months,1 year and then every year post-procedure.Results Transcatheter intervention for combined congenital heart disease was successful in all patients.Immediately after the procedure, there was no residual shunt in occluded PDAs or ASDs. The systolic pressure gradients across pulmonary valve,aortic valve and coarctation site decreased from 95.0±34.6 mm Hg to 17.0±5.2 mm Hg, 72mm Hg to 20mm Hg, and 37.0 mm Hg±4.5 mm Hg to 12 mm Hg±5.3 mm Hg, respectively,after balloon vavuloplasty or angioplasty.At 1.42±1.23 years follow-up, no residual shunt occurred and gradients across valve or coarctation site were within the limit of satisfactory result.No complications were observed. Conclusion Compared with that for simple congenital heart disease, transcatheter intervention for combined congenital heart disease is more difficult and demands higher-level technology.However, a good results could be obtained as long as indications and tactics of procedures were appropriate and manipulations conformed to standard.更多还原