中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2014年
5期
358-361
,共4页
郭颖%余志庆%刘廷亮%高伟%黄美容%李奋%傅立军%赵鹏军
郭穎%餘誌慶%劉廷亮%高偉%黃美容%李奮%傅立軍%趙鵬軍
곽영%여지경%류정량%고위%황미용%리강%부립군%조붕군
肺动脉瓣狭窄%支架%儿童
肺動脈瓣狹窄%支架%兒童
폐동맥판협착%지가%인동
Pulmonary valve stenosis%Stents%Child
目的 探讨应用支架治疗肺动脉分支狭窄的指征、方法和疗效评估.方法 2005年8月至2012年12月19例先天性心脏病患儿在上海交通大学医学院附属上海儿童医学中心接受了经血管内支架置入术治疗肺动脉分支狭窄,年龄9.1 (4.0～15.0)岁,体重31.7 (17.0～60.5)kg.其中14例为法洛四联症(TOF)术后残余左(右)肺动脉狭窄,其他为肺动脉闭锁合并室间隔缺损(PA/VSD)术后残余左、右肺动脉狭窄,室间隔完整的肺动脉闭锁(PA/IVS)术后残余右肺动脉狭窄,先天性左肺动脉狭窄,主肺动脉间隔缺损伴室间隔缺损(APW/VSD)术后残余左、右肺动脉狭窄,永存动脉干(PTA)术后残余右肺动脉狭窄各1例.根据造影所见,选用CP支架置入狭窄部位并应用BIB球囊扩张支架.术后2h行经胸超声心动图检查,观察支架位置及有无心包积液并测定心室收缩功能.手术次日行胸部X线片检查,观察支架位置.术后1、3、6及12个月复查心电图及超声心动图,观察支架有无移位、测定该部位的压力阶差及有无心律失常等.再根据情况每半年或1年随访1次.同一患者支架植入前后血管内径及右心室收缩压与主动脉收缩压比值的变化行配对￡检验.结果 19例患儿共置入支架26只.2例患儿支架移位至右室流出道.1例右肺动脉狭窄的患儿在支架置入到位后用球囊扩张支架孔眼时发生球囊破裂.支架置入后,跨狭窄处压差由术前(36.0±18.3) mmHg降至(3.8 ±3.4)mmHg(P＜0.01,1 mmHg =0.133 kPa);狭窄处内径由(6.0±1.9)mm增加至(11.6 ±3.1)mm(P ＜0.01);右室收缩压与主动脉收缩压之比由0.68降至0.49(P ＜0.01).随访时间6个月～6.0年,平均(2.5±1.8)年.除1例患儿出现血管成长性再狭窄,2年后再次球囊扩张成功外,其余无并发症发生.结论 球囊扩张型支架治疗儿童肺动脉分支狭窄安全可行,血管内支架置入术是肺动脉分支狭窄首选的治疗方法.儿童因成长出现血管再狭窄可通过再次球囊扩张取得良好治疗效果.
目的 探討應用支架治療肺動脈分支狹窄的指徵、方法和療效評估.方法 2005年8月至2012年12月19例先天性心髒病患兒在上海交通大學醫學院附屬上海兒童醫學中心接受瞭經血管內支架置入術治療肺動脈分支狹窄,年齡9.1 (4.0～15.0)歲,體重31.7 (17.0～60.5)kg.其中14例為法洛四聯癥(TOF)術後殘餘左(右)肺動脈狹窄,其他為肺動脈閉鎖閤併室間隔缺損(PA/VSD)術後殘餘左、右肺動脈狹窄,室間隔完整的肺動脈閉鎖(PA/IVS)術後殘餘右肺動脈狹窄,先天性左肺動脈狹窄,主肺動脈間隔缺損伴室間隔缺損(APW/VSD)術後殘餘左、右肺動脈狹窄,永存動脈榦(PTA)術後殘餘右肺動脈狹窄各1例.根據造影所見,選用CP支架置入狹窄部位併應用BIB毬囊擴張支架.術後2h行經胸超聲心動圖檢查,觀察支架位置及有無心包積液併測定心室收縮功能.手術次日行胸部X線片檢查,觀察支架位置.術後1、3、6及12箇月複查心電圖及超聲心動圖,觀察支架有無移位、測定該部位的壓力階差及有無心律失常等.再根據情況每半年或1年隨訪1次.同一患者支架植入前後血管內徑及右心室收縮壓與主動脈收縮壓比值的變化行配對￡檢驗.結果 19例患兒共置入支架26隻.2例患兒支架移位至右室流齣道.1例右肺動脈狹窄的患兒在支架置入到位後用毬囊擴張支架孔眼時髮生毬囊破裂.支架置入後,跨狹窄處壓差由術前(36.0±18.3) mmHg降至(3.8 ±3.4)mmHg(P＜0.01,1 mmHg =0.133 kPa);狹窄處內徑由(6.0±1.9)mm增加至(11.6 ±3.1)mm(P ＜0.01);右室收縮壓與主動脈收縮壓之比由0.68降至0.49(P ＜0.01).隨訪時間6箇月～6.0年,平均(2.5±1.8)年.除1例患兒齣現血管成長性再狹窄,2年後再次毬囊擴張成功外,其餘無併髮癥髮生.結論 毬囊擴張型支架治療兒童肺動脈分支狹窄安全可行,血管內支架置入術是肺動脈分支狹窄首選的治療方法.兒童因成長齣現血管再狹窄可通過再次毬囊擴張取得良好治療效果.
목적 탐토응용지가치료폐동맥분지협착적지정、방법화료효평고.방법 2005년8월지2012년12월19례선천성심장병환인재상해교통대학의학원부속상해인동의학중심접수료경혈관내지가치입술치료폐동맥분지협착,년령9.1 (4.0～15.0)세,체중31.7 (17.0～60.5)kg.기중14례위법락사련증(TOF)술후잔여좌(우)폐동맥협착,기타위폐동맥폐쇄합병실간격결손(PA/VSD)술후잔여좌、우폐동맥협착,실간격완정적폐동맥폐쇄(PA/IVS)술후잔여우폐동맥협착,선천성좌폐동맥협착,주폐동맥간격결손반실간격결손(APW/VSD)술후잔여좌、우폐동맥협착,영존동맥간(PTA)술후잔여우폐동맥협착각1례.근거조영소견,선용CP지가치입협착부위병응용BIB구낭확장지가.술후2h행경흉초성심동도검사,관찰지가위치급유무심포적액병측정심실수축공능.수술차일행흉부X선편검사,관찰지가위치.술후1、3、6급12개월복사심전도급초성심동도,관찰지가유무이위、측정해부위적압력계차급유무심률실상등.재근거정황매반년혹1년수방1차.동일환자지가식입전후혈관내경급우심실수축압여주동맥수축압비치적변화행배대￡검험.결과 19례환인공치입지가26지.2례환인지가이위지우실류출도.1례우폐동맥협착적환인재지가치입도위후용구낭확장지가공안시발생구낭파렬.지가치입후,과협착처압차유술전(36.0±18.3) mmHg강지(3.8 ±3.4)mmHg(P＜0.01,1 mmHg =0.133 kPa);협착처내경유(6.0±1.9)mm증가지(11.6 ±3.1)mm(P ＜0.01);우실수축압여주동맥수축압지비유0.68강지0.49(P ＜0.01).수방시간6개월～6.0년,평균(2.5±1.8)년.제1례환인출현혈관성장성재협착,2년후재차구낭확장성공외,기여무병발증발생.결론 구낭확장형지가치료인동폐동맥분지협착안전가행,혈관내지가치입술시폐동맥분지협착수선적치료방법.인동인성장출현혈관재협착가통과재차구낭확장취득량호치료효과.
Objective Branch pulmonary artery stenosis is one of the common congenital heart disease.Stent implantation to relieve branch pulmonary artery stenosis (BPAS) is an alternative to failed surgical or balloon angioplasty.The aim of this study was to explore the indication,methods and complications of using balloon expandable stent placement to treat branch pulmonary artery stenosis,and evaluate the results of stent implantation in the treatment of branch pulmonary artery stenosis.Method From August 2005 to December 2012,19 patients underwent an attempt at stent implantation.The median age of those patients was 9.1 years (range 4.0-15.0 years).The median weight was 31.7 kg (range 17.0-60.5 kg) ; 14/19 patients underwent post surgical repair of tetralogy of Fallot,one patient received post surgical repair of pulmonary atresia with ventricular septal defect,one patient underwent post surgical repair of pulmonary atresia with intact septum,one with native left BPAS,and one was after surgical repair of aortopulmonary window and the other truncus arteriosus.CP stent and NuMED Balloon-in-Balloon catheter were selected according to digital subtracted angiography measurements.After checking for correct position by angiography,the inner balloon and outer balloon was inflated successively to expand the stent to desired diameter.Statistical analysis was performed with the unpaired Student t test.Result A total of 26 stents were implanted successfully in 19 patients.The systolic gradient across the stenosis fell from a median of (36.0 ± 18.3) to (3.8 ± 3.4) mmHg (P＜0.01,1 mmHg=0.133 kPa) and the diameter of the narrowest segment improved from (6.0 ± 1.9) to (11.6 ± 3.1) mm (P＜0.01).The right ventricle to aortic pressure ratio fell from 0.68 to 0.49 (P ＜ 0.01).Complications included the following:two stents were malpositioned in the right ventricular outflow tract and one balloon ruptured when dilated the hole of the stent.No other complications occurred.All patients were followed up for 6 months to 6.0 (2.5 ± 1.8) years.One patient underwent stent re-dilation in order to accommodate somatic growth two years later.Conclusion Balloon expandable stents are safe and effective in relieving BPAS.Stent implantation should be considered the treatment of choice for most patients with BPAS.Stents placed into growing children will require further dilation to keep up with normal somatic growth.Intermediate and long-term follow up studies have shown excellent results after further dilation over time.
