摘要目的 探讨新生儿期采用经导管介入方法 治疗危重肺动脉瓣狭窄(critical pulmonarystenosis,CPS)及室间隔完整型肺动脉瓣闭锁(pulmonary atresia with intact ventricular septum.PA/IVS)的可行性.方法 2006年6月至2008年1月,采用经导管介入治疗13例新生儿(其中1例早产儿)危重先天性心脏病(CPS 9例,PA/IVS4例).男10例,女3例,年龄2～30(17.4±10.7)d,体重2.3～4.8(3.4±0.8)kg.术前及术中均使用前列腺素E.开放动脉导管.CPS患儿先采用直径2.5～4.0mm小球囊预扩张肺动脉瓣,再用1.0～1.2倍于肺动脉瓣环的球囊扩张肺动脉瓣.PA/IVS患儿先行射频瓣膜打孔,然后再行球囊瓣膜扩张术.结果 12例(92%)介入治疗成功.右室压力下降50%[术前(120.1±17.0)mm Hg(1 mm Hg=0.133 kPa),术后(58.8±7.7)mln Hg,P＜0.001].右室压力/体动脉压力比值下降44%[术前(1.6±0.2),术后(0.9±0.1),P＜0.001].右室造影显示肺动脉瓣开放.球囊/瓣环径比值1.1±0.1(最大球囊直径6～12 mm).手术时间(127.5±32.6)min,X线-曝光时间(25.2±7.2)min.术中4例(30%)出现并发症,2例心包积血,1例低氧血症,1例室上性心动过速.死亡1例(8%).全组随访1～18(7.2±6.4)个月.术后残余中至重度瓣膜狭窄3例,1例再次行球囊扩张术,另2例等待再次球囊扩张术;残余轻至中度瓣膜狭窄9例,所有患儿仅伴随轻度瓣膜反流,动脉导管自然闭合11例,近闭合1例.结论 经导管介入治疗新生儿CPS及PA/IVS是安全、有效的,部分患儿需二期介入治疗.

abstractsObjective To assess the feasibility of transcatheter intervention for critical pulmonaryarterial valve stenosis and atresia with intact ventricular septum in neonates. Methods From June 2006 toJanuary 2008, 13 neonates (9 with critical pulmonary arterial valve stenosis, 4 with pulmonary arterial valveatresia) underwent transcatheter intervention(one of them was premature neonate). Ten of the patients wereboys and 3 were girls. The mean age was (17.4±10.7) days. The mean weight was (3.4±0.8) kg. Allthe patients received prostaglandin E, infusion to dilate the ductus arteriosis before and during the procedure.Valvuloplasty was performed using a low-profile balloon (2.5-4.0 mm in diameter), and then a balloonapproximately 1.0-1.2 times the annulus diameter was applied. In patients with pulmonary atresia, the valvewas perforated with a radiofrequency wire, and then valvuloplasty was performed. Results Twelve patients(92%) were successfully treated with transcatheter intervention. Right ventricular systolic pressuredecreased by 50% [from (120. 1±17. 0) mm Hg (1mm Hg =0.133 kPa) to (58.8±7.7) mm Hg,P＜0. 001], and the ratio of the right ventricular systolic pressure to systemic systolic pressure decreased by44% [from (1.6±0.2) to (0.9±0. 1 ), P＜0. 001]. The right ventricular angingraphy showed that thepulmonary valves were opened. The ratio of the balloons to annulus were (1.1±0. 1) (the maximal balloonsize range from 6 to 12 mm). The procedure lasted for a mean of (127. 5±32. 6) minutes. The duration offluoroscopy was (25.2±7.2) minutes. Complications occurred in 4 patients (30%). Hemopericardiumoccurred in 2 patients, hypoxia in 1 patient and supraventricular tachycardia in 1 patient. One (8%) patientdied. The follow-up periods were (7.2±6.4) months. Three patients had moderate to severe residualpulmonary stenosis. One of them underwent a second balloon dilation at 3 months of follow-up. The other twowere waiting for the second dilation. Nine patients had mild to moderate residual pulmonary stenosis. Allpatients had mild pulmonary regurgitation. Ductus arteriosus was naturally closured in 11 patients, andnearly closured in 1 patient. Conclusions Transcatheter intervention for critical pulmonary stenosis andatresia with intact ventricular septum in neonates is safe and effective. Some patients may require repeatballoon valvuloplasty.