新生兒及嬰兒期危重先心病介入治療

新生兒及嬰兒期危重先心病介入治療

四川大學(xué)華西第二醫(yī)院心臟介入中心華益民新生兒PBPV近期并發(fā)癥：

1、短暫心動(dòng)過緩、早搏、體循環(huán)壓力不能維持；

2、失血（特別是介入治療早期器械原因）；

3、股動(dòng)脈、靜脈栓塞；

4、CRBBB、短暫的AVB、腦血管意外、意識(shí)喪失、驚厥、三尖瓣及乳頭肌斷裂、肺動(dòng)脈瓣撕裂；

5、QTc延長(zhǎng)導(dǎo)致室性心動(dòng)過速。Significantpulmonaryvalveincompetencefollowingoversizeballoonpulmonaryvalveplastyinsmallinfants.CatheterCardiovascInterv.1999,48:61-65PercutaneousBalloonPulmonaryValvuloplasty:StateoftheArt.CatheterizationandCardiovascularInterventions,2007,69:747–63Significantpulmonaryvalveincompetencefollowingoversizeballoonpulmonaryvalveplastyinsmallinfants.CatheterCardiovascInterv.1999,48:61-65PercutaneousBalloonPulmonaryValvuloplasty:StateoftheArt.CatheterizationandCardiovascularInterventions,2007,69:747–63PBAV前:?P84mmHgPBAV后:?P14mmHg

AorticWallInjuryasaComplicationofNeonatalAorticValvuloplasty.Circulation:cardiovascularinterventions,2008,1:53-9LeftHeartGrowth,Function,andRe-interventionAfterBalloonAorticValvuloplastyforNeonatalAorticStenosis.Circulation,2005,111:451-8PBAV死亡原因分析：1、原發(fā)疾病程度重，機(jī)體各項(xiàng)機(jī)能處于失代償邊緣；2、主動(dòng)脈壁損傷，血管夾層，血管破裂；3、心臟穿孔、心包填塞；4、腦血管意外、意識(shí)喪失、驚厥；5、原發(fā)疾病危重，影響肝素等抗凝劑的代謝，促進(jìn)DIC出現(xiàn)。Barbero-MarcialM,EbaidM.Evolutionalaspectsofchildrenandadolescentswithsurgicallycorrectedaorticcoarctation:clinical,echocardiographic,andmagneticresonanceimageanalysisof113patients.JThoracCardiovascSurg2004Vascularremodelingafter“successful”repairofcoarctation:impactofaorticarchgeometry.JAmCollCardiol2007Secondarysubaorticstenosisinheartdefectswithoutanyinitialsubaorticobstruction:amultifactorialpostoperativeevent.EurJCardiothoracicSurg2007Initialresultsandmedium-termfollow-upofstentimplantationofpatentductusarteriosusinduct-dependentpulmonarycirculation.JAmCollCardiol.2004,44:438-45StentingofthearterialductandbandingofthepulmonaryarteriesbasisforcombinedNorwoodIandIIrepairinhypoplasticleftheart.Circulation.2002,105:1099-103Stentingofthearterialductinnewbornswithduct-dependentpulmonarycirculation.Heart.2008,94:925-9Initialresultsandmedium-termfollow-upofstentimplantationofpatentductusarteriosusinduct-dependentpulmonarycirculation.JAmCollCardiol.2004,44:438-45StentingofthearterialductandbandingofthepulmonaryarteriesbasisforcombinedNorwoodIandIIrepairinhypoplasticleftheart.Circulation.2002,105:1099-103Stentingofthearterialductinnewbornswithduct-dependentpulmonarycirculation.Heart.2008,94:925-9Ductalstentingforrestrictedpulmonarybloodflowinneonates15yearsonbutstillaverylimitedplaceinclinicalpractice.Heart.2008,94:834-5Stentingofbilateralarterialductsincomplexcongenitalheartdisease.PediatrCardiol.2008,29:842-5Scoringsystemtodetermineneedforballoonatrialeptostomyforrestrictiveinteratrialcommunicationininfantswithhypoplasticleftheartsyndrome.JHeartLungTransplant.2003V22N8:883-888伴限制性房間通道的復(fù)雜型先心病需要BAS的評(píng)分系統(tǒng)項(xiàng)目數(shù)值分值通過IAV的Vmax（m/s）＜1.511.5-1.82＞1.83單孔IAC直徑（mm）＞4.513.5-4.52＜3.53多孔IAC面積（mm2）＞15110-152＜103血氧飽和度（FiO221%）＞85%180-84%2

＜80%3IAC:interatrialcommunication分值3-9分，≥6分需要進(jìn)行BAS

復(fù)雜先心病血氧飽和度越低，體循環(huán)血量越不足，以及兩種情況持續(xù)時(shí)間越長(zhǎng)，腦室周圍白質(zhì)軟化、腦栓塞、腦卒中等腦損傷的發(fā)生幾率明顯增加。因而，采用BAS、PDA支架置入等恰當(dāng)?shù)墓孟⒅委煼绞絹?lái)改善體循環(huán)的氧合狀態(tài)、增加左心系統(tǒng)壓力及血流量對(duì)改善復(fù)雜先心病的預(yù)后及生存質(zhì)量非常重要。Pre-operativebraininjuryinnewborninfantswithtranspositionofthegreatarteriesoccursatratessimilartoothercomplexcongenitalheartdiseaseandisnotrelatedtoballoonatrial;JAmCollCardiol.2009Balloonatrialseptostomylet'stakeacloserlook.JAmCollCardiol.2009年齡問題：1、在Boston兒童醫(yī)院PBAV系列報(bào)道中：

1-7天：63例（56%），死亡14例，死亡率22%