【摘要】 目的回顾性总结镶嵌技术即经食道超声(transesophageal echocardiography,TEE)引导下经胸小切口肺动脉瓣球囊扩张术治疗新生儿危重肺动脉瓣狭窄(critical pulmonary stenosis,CPS)即刻疗效及短中期随访结果,评价其安全性与有效性。方法纳入2015年7月至2018年10月在大连市儿童医院接受镶嵌技术治疗的9例CPS新生儿。全组患儿由同一组经验丰富的高资历医生团队实施手术。回顾性统计所有患儿的临床资料,包括性别、年龄、体质量、球囊扩张前后血流动力学参数变化、监护室及住院治疗数据、随访结果。结果除第1例患儿因经验不足球囊移位导致右心室流出道撕裂,急行体外循环下肺动脉瓣交界切开+BT分流术外,其余8例镶嵌技术治疗均获成功,无手术死亡,均顺利出院。球囊扩张后即刻肺动脉瓣跨瓣压差由(108.3±16.6)mmHg(1 mmHg=0.133 mmHg)降至(33.7±11.4)mmHg(P<0.001),右心室压力由(119.7±16.3)mmHg降至(45.2±10.5)mmHg,右心室压力与主动脉压力比值明显下降(1.6±0.3 vs. 0.8±0.2,P<0.001)。3例实施了动脉导管支架置入术,3例结扎动脉导管后加行BT分流术,2例术后前列腺素(prostaglandin E,PGE)泵维持1周后停药,动脉导管自然闭合。出院时8例患儿平均血氧饱和度升至87.5%。随访(22.5±6.5)个月,超声显示3例患儿肺动脉瓣轻度反流,1例患儿肺动脉瓣中度反流。4例Ⅱ期行双心室根治术,1例Ⅱ期行一个半心室矫治术,3例等待做Ⅱ期手术。结论镶嵌技术对于治疗新生儿CPS是一种安全、有效、可行的治疗措施,有很高的临床推广价值。更多还原

【Abstract】 Objectives To retrospectively summarize the immediate therapeutic outcomes and medium-term follow-up of hybrid therapy in neonates with critical pulmonary stenosis(CPS)solely guided by transthoracic echocardiography(TTE). Methods This study was a retrospective study. Form July 2015 to October 2018,9 infants with CPS received hybrid therapy in Dalian Children′s Hospital were enrolled in our study. All the cases were operated by one team of experienced highly qualified doctors. The clinical data of each case were recorded in detail and statistically analyzed,including gender,age,weight,changes of immediate hemodynamic parameters before and after surgery,data of custody and hospitalization,and follow-up results. Results One case with right ventricular outflow tract laceration due to balloon transposition was changed to pulmonary angioplasty and BT shunt under extracorporeal circulation. The other 8 cases were successfully treated with hybrid technique,and all of whom were successfully discharged. Immediately after balloon,the pressure gradient across the pulmonary valve decreased from(108.3±16.6)mmHg to(33.7±11.4)mmHg(1 mmHg=0.133 kPa)(P<0.001). The right ventricular systolic pressure decreased from(119.7±16.3)mmHg to(45.2±10.5)mmHg(P<0.001),and the ratio of right ventricular pressure to aortic pressure decreased significantly(1.6±0.3 vs. 0.8±0.2,P<0.001). Three cases were performed stent implantation in arterial catheter,3 cases were ligated arterial catheter followed by BT shunt,and two were treated with prostaglandin E(PGE)pump for 1 week after surgery,the arterial catheter was closed naturally. The average oxygen saturation of 8 children increased to 87.5% at discharge. During the follow-up of(22.5±6.5)months,3 cases were found to have mild pulmonary regurgitation,and 1 case had moderate pulmonary regurgitation. Four patients were treated with stage Ⅱ double ventricle radical surgery,one with stage II half ventricle correction,and three were waiting for stage Ⅱ surgery. Conclusions Hybrid technology is a safe,effective and feasible therapeutic measure for the treatment of neonatal CPS. It has high clinical value.更多还原