本文選題：肺動脈分支狹窄 + 支架�。� 參考：《首都醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討應(yīng)用支架植入術(shù)治療肺動脈分支狹窄的指征、方法及效果。方法:7例患有復(fù)雜先天性心臟病外科術(shù)后殘余肺動脈分支狹窄的患兒接受了經(jīng)導(dǎo)管支架植入的介入治療。平均年齡(8.7±6.3)歲(4~18歲),平均體重(28.4±17.3)kg(13~56kg)。男女比例4:3。結(jié)果:法洛四聯(lián)癥(tetralogy of Fallot,TOF)術(shù)后殘留左肺動脈或右肺動脈狹窄者6例,分別植入右肺動脈支架4例,左肺動脈支架2例;矯正型大動脈轉(zhuǎn)位(c TGA)1例,植入左肺動脈支架1例。早期隨訪:支架植入后,左、右肺動脈狹窄處內(nèi)徑由術(shù)前的(4.1±1.0mm)增寬至(10.9±2.7mm);狹窄處壓差(ΔP)由術(shù)前的(62.0±12.0mm Hg)降低至(34.9±16.8mm Hg);中期隨訪:支架植入后,左、右肺動脈狹窄處內(nèi)徑由術(shù)前的(4.1±1.0mm)增寬至(10.1±2.1mm);狹窄處壓差(ΔP)由術(shù)前的(62.0±12.0mm Hg)降低至(29.6±12.7mm Hg);三尖瓣瓣環(huán)收縮位移(tricuspid annular plane systolic excursion,TAPSE)由術(shù)前的(12.4±3.5mm)增至(18.6±5.1mm),超聲TDI:右室心肌收縮速度由術(shù)前的(7.6±1.8cm/s)增大至(11.2±3.9cm/s),舒張期e’由術(shù)前的(4.8±2.0cm/s)增大至(10.6±3.5cm/s)。術(shù)后患兒經(jīng)皮血氧飽和度增加,活動耐量明顯增加,NYHA分級提高至Ⅰ-Ⅱ級,隨訪過程中復(fù)查超聲心動圖,狹窄處內(nèi)徑較前明顯增寬,右心功能較前明顯改善,無再狹窄、栓塞及心內(nèi)膜炎等并發(fā)癥發(fā)生,也未發(fā)生支架位移、支架斷裂等需外科干預(yù)者。結(jié)論:肺動脈支架治療肺動脈分支狹窄,狹窄處梗阻解除,肺血流量趨向正常,經(jīng)皮血氧飽和度提升,右心功能改善,患者活動耐量提高,是目前肺動脈分支狹窄的理想治療方法。
[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 鹵6.3) years (4 / 18) and the average weight was (28.4 鹵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 鹵1.0mm) to (10.9 鹵2.7mm), the pressure difference of stenosis (螖 P) decreased from (62.0 鹵12.0mm Hg) to (34.9 鹵16.8mm Hg). The diameter of right pulmonary artery stenosis increased from (4.1 鹵1.0mm) to (10.1 鹵2.1mm), the pressure difference of stenosis (螖 P) decreased from (62.0 鹵12.0mm Hg) to (29.6 鹵12.7mm Hg), the systolic displacement of tricuspid annulus (tricuspid annular plane systolic excursion TAPSE) increased from (12.4 鹵3.5mm) to (18.6 鹵5.1mm), and the systolic velocity of right ventricular myocardium increased from (12.4 鹵3.5mm) to (18.6 鹵5.1mm). The anterior (7.6 鹵1.8cm/s) increased to (11.2 鹵3.9cm/s), and the diastolic E 'increased from (4.8 鹵2.0cm/s) to (10.6 鹵3.5cm/s). The transcutaneous oxygen saturation was increased, and the NYHA grade was increased to grade 鈪，

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