房间隔缺损合并肺动脉瓣狭窄患者同期行介入治疗的疗效评价.doc

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1、房间隔缺损合并肺动脉瓣狭窄患者同期行介入治疗的疗效评价作者：代政学，张玉顺，王海昌，贾国良，刘建平，王小燕【关键词】房间隔缺损Concurrentpercutaneousatrialseptaldefectclosureandpulmonaryvalvuloplasty[Abstract】AIM:ToevaluatetheeffectivenessandshorttermresultsofcombinedpercutaneousbalIonpulmonaryvalvuloplasty(PBPV)andatrialseptalde

2、fectclosureforpulmonaryvalvularstenosis(PS)associatedwithseccundumatrialseptaldefect(ASD).METHODS:Eightpatients,3~37(13±15)yearsold,wereconfinnedwithASDinassociationwithPSbytransthoracicechocardiography(TTE).Percutaneousbal1oonpulmonaryvalvuloplasty(PBPV)wasdoneiniti

3、ally;ASDwasclosedlaterusingAmplatzeroccluderdeviceunderguidanceoffluoroscopyandtransesophagealechocardiography(TEE)orTTE,TTEwereperformedimmediatelyand24h,1mo,3moand6moafterocclusiontoevaluatetheefficiency・RESULTS:Theprocedurewassuccessfulinall8patients・Rightventricu

4、larsystolicpressuresignifleantlydecreasedfrom(11.57+4.09)kPato[5.49±2.09kPa(P<0.001)]・Thetranspulmonaryvalvesystolicgradientsignificantlydecreasedfrom(7.57+4.49)kPato[1.89+1.63kPa(P<0.001)]immediatelyafterPBPV:Noresidualshuntofatrialseptalwasfoundin8patientsimm

5、ediatelyaftertheprocedureandinthefo11owup.CONCLUSION:SimultaneousPBPVandclosureoftheASDappearstobeaneffectiveandsafemodalityforPSassociatedwithASD・Itshouldbeanalternativetosurgery.[Keywords]heartseptaldefects,atrial:pulmonaryvalvestenosis：heartcatheterization【摘耍】目的：初

6、步评价房间隔缺损合并肺动脉瓣狭窄同期行介入治疗的疗效.方法：8例患者，年龄：T37(13±15)岁，经临床及超声心动图确诊为房间隔缺损合并肺动脉瓣狭窄.术前行彩色多普勒超声心动图检查，术中均行右室造影证实诊断.首先在透视下经皮球囊肺动脉瓣成形术(PBPV)治疗肺动脉瓣狭窄(PS),术后即时右心导管观察右心室压力和跨肺动脉瓣压力压差变化；然后在食管超声心动图或经胸超声心动图监视下经导管置入Amplatzer伞封堵房间隔缺损，术后即时彳亍超声心动图，术后24h,1mo,3mo和6mo分别行经胸超声心动图评价房间隔缺损治疗效果.结果：

7、8例患者疗效均佳，PBPV术后即刻右室收缩压由(11.57±4.09)kPa降至(5.49±2.09)kPa(P<0.001),肺动脉至右心室跨瓣压差由(7.57±4.49)kPa降至(1.89±1.63)kPa(P<0.001).房间隔未见残余分流.结论：房间隔缺损合并肺动脉瓣狭窄同期行介入治疗疗效可靠，是外科治疗的一种有效替代治疗.【关键词】房间隔缺损；肺动脉瓣狭窄；心脏导管插入术0引言房间隔缺损(ASD)是常见的先天性心脏病，以往手术是其唯一的治疗方法•随着介入医学的发展，己有若干器械应用于ASD的介入治疗，其

8、屮Amplatzer封堵器具有操作简便、成功率高、残余分流发生率低等优点，现在国内外广泛用于ASD的治疗[1-6]・经皮球囊肺动脉瓣成形术(PBPV)是一种解除单纯肺动脉瓣狭窄(PS)的非手术疗法[7-9]・但是对于ASD合并PS同期行介入治疗国内外报道较少.我