CAJ | 학술논문

目的探讨经食管超声心动图(TEE)在新生儿危重型肺动脉瓣狭窄(CPS)非体外循环下经胸肺动脉瓣球囊扩张镶嵌治疗中的应用价值,总结操作要点.方法回顾性分析15例在TEE引导下经胸肺动脉瓣球囊扩张成形术治疗新生儿CPS的镶嵌治疗,所有患儿均胸骨正中切口,于右室流出道距离肺动脉瓣环下约2 cm缝荷包线,在TEE引导下置入导丝和穿刺鞘管.确认穿刺针对准肺动脉瓣后,在钢丝引导下放入球囊扩张管进行扩张,TEE观察肺动脉瓣开放情况,测量跨瓣压差.结果在TEE引导下,15例球囊扩张成形术均成功完成,未出现严重并发症.即时肺动脉跨瓣压力阶差(PTG)和右心室压力阶差均显著下降,与术前比较,差异有统计学意义(P＜0.01).术后随访6～36个月,除1例患儿存在残余梗阻外,其余患儿生长发育良好,无再狭窄发生,三尖瓣反流量均不同程度减轻.结论在TEE辅助下,镶嵌治疗新生儿CPS是安全有效的方法,具有创伤小、恢复快、手术时间短、无需体外循环辅助等优点.
목적 탐토경식관초성심동도(TEE)재신생인위중형폐동맥판협착(CPS)비체외순배하경흉폐동맥판구낭확장양감치료중적응용개치,총결조작요점.방법 회고성분석15례재TEE인도하경흉폐동맥판구낭확장성형술치료신생인CPS적양감치료,소유환인균흉골정중절구,우우실류출도거리폐동맥판배하약2 cm봉하포선,재TEE인도하치입도사화천자초관.학인천자침대준폐동맥판후,재강사인도하방입구낭확장관진행확장,TEE관찰폐동맥판개방정황,측량과판압차.결과 재TEE인도하,15례구낭확장성형술균성공완성,미출현엄중병발증.즉시폐동맥과판압력계차(PTG)화우심실압력계차균현저하강,여술전비교,차이유통계학의의(P＜0.01).술후수방6～36개월,제1례환인존재잔여경조외,기여환인생장발육량호,무재협착발생,삼첨판반류량균불동정도감경.결론 재TEE보조하,양감치료신생인CPS시안전유효적방법,구유창상소、회복쾌、수술시간단、무수체외순배보조등우점.
Objective To investigate the clinical application value of transesophageal echocardiography(TEE) in off-pump hybrid therapy of transthoracic balloon pulmonary valvuloplasty for neonatal critical pulmonary stenosis(CPS),and summarize the key points of the operation.Methods Fifteen neonates with CPS underwent hybrid therapy of transthoracic balloon pulmonary valvuloplasty guided by TEE were reanalyzed retrospectively.All patients were performed with a median sternotomy.A purse-string suture was placed in the right ventricular outflow tract 2 cm away from the pulmonary trunk,and then a guide wire and a puncture sheath pipe were inserted.The open situations of pulmonary valves and the transpulmonary valvular gradient pressure were observed by TEE after sequential dilations.Results Fifteen patients for balloon valvuloplasty were all successfully performed with the guidance of TEE,and no severe complications occurred.Both transpulmonary valvular gradient pressure(PTG) and right ventricular systolic pressure decreased significantly compared with those before operation(P ＜0.01).All patients recovered well except for one with residual obstruction followed up at 6 months to 3 years after operation.Conclusions The hybrid therapy without extracorporeal circulation guided by TEE for neonatal CPS is safe and effective,which has the advantages of short operative time,less injury,quicker rehabilitation,etc.