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目的:总结10例肺动脉瓣狭窄婴幼儿在食道超声心动图(transesophageal echocardiography,TEE)引导下,经胸小切口行肺动脉瓣球囊扩张术(简称杂交手术)的疗效。方法:2009年9月至2015年12月中南大学湘雅二医院共收治10例肺动脉瓣狭窄婴幼儿,其中男6例,女4例;年龄0.7~42(14.8±15.8)个月,其中新生儿2例;合并房间隔缺损2例,卵圆孔未闭6例,动脉导管未闭1例,肌部室间隔缺损2例,永存左上腔静脉1例,三尖瓣反流5例,均在TEE引导下接受杂交手术治疗。结果:术后所有患儿均入重症监护室继续治疗,呼吸机辅助0.5~41(6.8±12.3)h。监护室停留时间2~85(31.1±22.8)h,住院时间6~20(11.4±5.1)d。术后肺动脉跨瓣压差降至16~45(31.1±9.8)mm Hg,较术前明显降低(P<0.001)。全组无住院死亡,所有患儿术后恢复良好,顺利出院。结论:在TEE引导下行杂交手术治疗婴幼儿肺动脉瓣狭窄是一种安全、疗效优良的治疗策略。
Objective: To summarize the curative effect of pulmonary valvuloplasty (abbreviated as hybridization) in 10 infants with pulmonary valve stenosis under transesophageal echocardiography (TEE) guided by small incision. Methods: From September 2009 to December 2015, 10 cases of pulmonary valve stenosis infants, including 6 males and 4 females, were enrolled in the Second Xiangya Hospital of Central South University. Their ages ranged from 0.7 to 42 (14.8 ± 15.8) months. In 2 cases; with atrial septal defect in 2 cases, patent foramen ovale in 6 cases, patent ductus arteriosus in 1 case, muscular ventricular septal defect in 2 cases, permanent left superior vena cava in 1 case, tricuspid regurgitation in 5 cases, both in Under the guidance of TEE hybrid surgery. Results: All patients were admitted to intensive care unit for follow-up. The ventilator assisted 0.5 ~ 41 (6.8 ± 12.3) h. The stay in the care unit was 2 ~ 85 (31.1 ± 22.8) h and the length of stay was 6 ~ 20 (11.4 ± 5.1) days. Postoperative pulmonary valve transvalvular pressure decreased to 16-45 (31.1 ± 9.8) mm Hg, significantly lower than the preoperative (P <0.001). The whole group died without hospitalization, all children recovered well and discharged successfully. CONCLUSION: TEE-guided down-crossing surgery for pulmonary artery stenosis in infants is a safe and effective therapeutic strategy.