支架在复杂先天性心脏病术后残余肺动脉分支狭窄中的应用

发布时间：2018-06-23 02:03

  本文选题：肺动脉分支狭窄 + 支架　； 参考：《首都医科大学》2017年硕士论文

【摘要】：目的:探讨应用支架植入术治疗肺动脉分支狭窄的指征、方法及效果。方法:7例患有复杂先天性心脏病外科术后残余肺动脉分支狭窄的患儿接受了经导管支架植入的介入治疗。平均年龄(8.7±6.3)岁(4~18岁),平均体重(28.4±17.3)kg(13~56kg)。男女比例4:3。结果:法洛四联症(tetralogy of Fallot,TOF)术后残留左肺动脉或右肺动脉狭窄者6例,分别植入右肺动脉支架4例,左肺动脉支架2例;矫正型大动脉转位(c TGA)1例,植入左肺动脉支架1例。早期随访:支架植入后,左、右肺动脉狭窄处内径由术前的(4.1±1.0mm)增宽至(10.9±2.7mm);狭窄处压差(ΔP)由术前的(62.0±12.0mm Hg)降低至(34.9±16.8mm Hg);中期随访:支架植入后,左、右肺动脉狭窄处内径由术前的(4.1±1.0mm)增宽至(10.1±2.1mm);狭窄处压差(ΔP)由术前的(62.0±12.0mm Hg)降低至(29.6±12.7mm Hg);三尖瓣瓣环收缩位移(tricuspid annular plane systolic excursion,TAPSE)由术前的(12.4±3.5mm)增至(18.6±5.1mm),超声TDI:右室心肌收缩速度由术前的(7.6±1.8cm/s)增大至(11.2±3.9cm/s),舒张期e’由术前的(4.8±2.0cm/s)增大至(10.6±3.5cm/s)。术后患儿经皮血氧饱和度增加,活动耐量明显增加,NYHA分级提高至Ⅰ-Ⅱ级,随访过程中复查超声心动图,狭窄处内径较前明显增宽,右心功能较前明显改善,无再狭窄、栓塞及心内膜炎等并发症发生,也未发生支架位移、支架断裂等需外科干预者。结论:肺动脉支架治疗肺动脉分支狭窄,狭窄处梗阻解除,肺血流量趋向正常,经皮血氧饱和度提升,右心功能改善,患者活动耐量提高,是目前肺动脉分支狭窄的理想治疗方法。
[Abstract]:Objective: to investigate the indications, methods and effects of stent implantation in the treatment of pulmonary artery stenosis. Methods Seven children with residual pulmonary artery stenosis after surgical operation of complex congenital heart disease were treated with transcatheter stent implantation. The average age was (8.7 卤6.3) years (4 / 18) and the average weight was (28.4 卤17.3) kg (13~56kg). The ratio of men to women is 4: 3. Results: 6 cases of residual left pulmonary artery or right pulmonary artery stenosis were implanted into right pulmonary artery stents in 4 cases and left pulmonary artery stents in 2 cases, corrected transposition of great arteries (c TGA) in 1 case and left pulmonary artery stent in 1 case. Early follow-up: after stent implantation, the diameter of stenosis of left and right pulmonary artery widened from (4.1 卤1.0mm) to (10.9 卤2.7mm), the pressure difference of stenosis (螖 P) decreased from (62.0 卤12.0mm Hg) to (34.9 卤16.8mm Hg). The diameter of right pulmonary artery stenosis increased from (4.1 卤1.0mm) to (10.1 卤2.1mm), the pressure difference of stenosis (螖 P) decreased from (62.0 卤12.0mm Hg) to (29.6 卤12.7mm Hg), the systolic displacement of tricuspid annulus (tricuspid annular plane systolic excursion TAPSE) increased from (12.4 卤3.5mm) to (18.6 卤5.1mm), and the systolic velocity of right ventricular myocardium increased from (12.4 卤3.5mm) to (18.6 卤5.1mm). The anterior (7.6 卤1.8cm/s) increased to (11.2 卤3.9cm/s), and the diastolic E 'increased from (4.8 卤2.0cm/s) to (10.6 卤3.5cm/s). The transcutaneous oxygen saturation was increased, and the NYHA grade was increased to grade 鈪，

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