上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (9): 1291-.doi: 10.3969/j.issn.1674-8115.2011.09.018

• 论 著 • 上一篇    下一篇

室间隔完整型肺动脉闭锁的镶嵌治疗

董 卫, 张海波   

  1. 上海交通大学 医学院附属上海儿童医学中心心胸外科, 上海 200127
  • 出版日期:2011-09-28 发布日期:2011-09-27
  • 作者简介:董 卫（1981—）, 男, 住院医师, 硕士；电子信箱: glass_d.scmc@yahoo.com.cn。

Hybrid approaches for pulmonary atresia with intact ventricular septum

DONG Wei, ZHANG Hai-bo   

  1. Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2011-09-28 Published:2011-09-27

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摘要：

目的 总结室间隔完整型肺动脉闭锁患儿在开胸非体外循环下肺动脉瓣穿刺球囊扩张的镶嵌治疗经验。方法 回顾性分析11例室间隔完整型肺动脉闭锁患儿行镶嵌治疗肺动脉瓣穿刺球囊扩张术，记录手术资料和术后监护数据。结果 9例室间隔完整型肺动脉闭锁，2例重度肺动脉狭窄接近闭锁，右心室发育尚可，三尖瓣Z值>-2，全组均采用开胸术非体外循环下穿刺球囊扩张肺动脉瓣，手术无死亡病例。术后患儿的平均血氧饱和度达到(90±4)%，无球囊扩张相关并发症。2例患儿出现低心排血量综合征，无住院死亡。平均随访时间(8±3)个月，所有患儿仍均伴有轻-中度肺动脉狭窄，1例患儿因术后肺动脉狭窄再次行右心室流出道补片扩大手术。结论 镶嵌方法行肺动脉瓣切开可以有效治疗新生儿室间隔完整型肺动脉闭锁；可提供足够的肺血流促进三尖瓣以及右心室发育，可消除常规外科手术体外循环对于心脏的创伤，避免导管产生并发症，提高操作的安全性和成功率。

关键词: 镶嵌治疗, 球囊扩张, 室间隔完整型肺动脉闭锁

Abstract:

Objective To investigate the outcome of hybrid approaches of balloon valvuloplasty via pulmonary valve without cardiopulmonary bypass for pulmonary atresia with intact ventricular septum in neonates. Methods Eleven patients undergoing hybrid approaches of balloon valvuloplasty via pulmonary valve for pulmonary atresia with intact ventricular septum were selected, and the clinical features and surgical procedures were recorded. Results Among the 11 patients, there were 9 with pulmonary atresia with intact ventricular septum and 2 with severe pulmonary stenosis. The right ventricles were normally developed, and the Z values of tricuspid valves were >-2. All patients underwent balloon valvuloplasty via pulmonary valve without cardiopulmonary bypass, and there was no death during operation. The mean blood oxygen saturation after operation was (90±4)%, and there was no complication related to balloon valvuloplasty. Low cardiac output syndrome occurred in 2 patients, and there was no in-hospital death. Patients were followed up for an average of (8±3) months, all patients had mild to moderate pulmonary stenosis, and 1 needed a right ventricular outflow tract patch for pulmonary stenosis after operation. Conclusion Pulmonary valvuloplasty with hybrid technique is effective in management of pulmonary atresia with intact ventricular septum in neonates, which may provide adequate pulmonary blood flow and promote further growth of tricuspid valve and right ventricular cavity with less trauma and more safety.

Key words: hybrid approach, balloon dilation, pulmonary atresia with intact ventricular septum