• 短篇与病例报告 •    

体肺分流管道梗阻的介入治疗二例

张炜   

  1. 天津市胸科医院
  • 收稿日期:2010-06-04 修回日期:2010-07-01 出版日期:2010-09-15 发布日期:2010-09-15
  • 通讯作者: 张炜

Catheter Interventional Treatment of systemic-to-pulmonary arterial shunt obstruction

  • Received:2010-06-04 Revised:2010-07-01 Published:2010-09-15 Online:2010-09-15

摘要: 【摘要】 目的:体肺动脉分流术仍然是新生儿依赖动脉导管肺循环的一线治疗,或左心发育不良综合征病人Norwood 手术的一部分。这种外科手术术后的急性并发症,例如分流管道狭窄,栓塞,或扭转,都对病人存在潜在的生命威胁。如出现这些并发症,需要立即手术修复或更换分流管道。在这篇报道里,讨论了3例Norwood 术后体肺分流管道急性狭窄的病人,应用介入治疗作为外科手术的另一个选择。方法:病人的年龄从4个月-6个月,体重范围在4.2-6.2kg。一例为改良BT分流,两例为Sano分流(右室至肺动脉分流)。结果:在3例病人的4次介入治疗中,放置了5枚冠脉支架。应用球囊的直径与分流管道的比例平均1比1。所有的分流管道被支架成功的再打开。随访中,都在良好的血液动力学基础上做了进一步手术。结论:在我们有限的经验中,支架植入成为体肺分流梗阻并发症的及时有效的治疗方法。

Abstract: 【Abstract】 Objective: Creation of a systemic-to-pulmonary shunt is still the firstline treatment in neonates with ductdependent pulmonary circulation, or in patients with hypoplastic left heart syndrome as a part of the first stage of the Norwood sequence. Acute complications after such surgery, such as stenosis, thrombosis, or kinking, are potentially lifethreatening. These complications require immediate revision or exchange of the shunt. In this report, we discuss interventional treatment as an alternative to surgery in 3 patients with acute stenosis of a shunt. Methods:The age of the patients ranged from 4 to 6 months, and their weights ranged between 4.2 and 6.2 kg. In 1 patients, the shunts were modified Blalock-Taussig type, while the 2 patients had shunts from the right ventricle to the pulmonary arteries.Results:We implanted 5 coronary arterial stent systems in 4 interventions. The diameter of the balloon used for implantation had a ratio to the shunt of 1. to 1. All shunts were successfully reopened by stenting. During follow-up, 3 patients underwent further procedures on an elective basis. Conclusion: In our limited experience, implantation of stents is an effective treatment for complications of shunts.