2019 年第 11 期 第 14 卷

超声监测与心血管造影在小儿先天性心脏病介入治疗中的指导作用

Guiding roles of echocardiography and angiocardiography in interventional treatment of congenital heart disease in children

作者：罗培李成王锦亮方向

英文作者：

单位：618000四川省德阳市人民医院超声科

英文单位：

关键词：先天性心脏病；超声心电图；心血管造影

英文关键词：

• 摘要：

• 【摘要】目的    探讨超声心动图与心血管造影（ACG）在小儿先天性心脏病（CHD）介入治疗中的指导作用。方法    选择2010年1月至2018年12月四川省德阳市人民医院收治的108例CHD患儿，其中室间隔缺损（VSD）38例、动脉导管未闭（PDA）52例、肺动脉瓣狭窄（PS）18例。所有患儿于介入术前行经胸超声心动图（TTE）检测和ACG检查，酌情行TTE或ACG引导下CHD介入治疗，观察2种方法的诊断率、病变直径测量值及各自引导下的介入封堵术治疗结果。结果    本组TTE和ACG对VSD、PDA及PS的术前确诊率均为100%。104例患儿符合介入治疗指征。PDA患儿（50例）的TTE病变直径测量值大于ACG测量值［（4.0±1.3）mm比（3.3±1.0）mm］，差异有统计学意义（t=2.75，P<0.01）；VSD、PS患儿（36例、18例）的TTE与ACG病变直径测量值差异无统计学意义（P>0.05）。TTE引导下CHD介入治疗成功率为93.3%（28/30），ACG引导下介入成功率为96.0%（71/74），差异无统计学意义（χ2=0.732，P=0.184）。封堵失败的5例患儿均无证据显示治疗失败与影像学引导选择有关。封堵成功的99例患儿术后造影有13例存在细小分流，24 h超声检查分流均消失。结论    TTE和ACG针对不同类型的CHD介入治疗各具优势，需发挥二者的互补作用、以期达到良好的诊断治疗效果。

• 【Abstract】Objective    To investigate the guiding roles of echocardiography and angiocardiography(ACG) in interventional treatment of congenital heart disease(CHD) in children. Methods    A total of 108 children with CHD admitted to People′s Hospital of Deyang City, Sichuan Province from January 2010 to December 2018 were enrolled, including 38 cases of ventricular septal defect(VSD), 52 cases of patent ductus arteriosus(PDA) and 18 cases of pulmonary artery stenosis(PS). All children underwent transthoracic echocardiography(TTE) and ACG; transcatheter closure guided by TTE or ACG was performed as appropriate. Diagnostic rate, measurements of lesion diameter and the therapeutic effect of operation with TTE or ACG guidance were analyzed. Results    Preoperative diagnostic rates of TTE and ACG for VSD, PDA and PS were 100%. Among 104 children who met the indication of interventional treatment, measurement of lesion diameter of TTE in children with PDA (n=50) was significantly higher than that of ACG［(4.0±1.3)mm vs (3.3±1.0)mm］(t=2.75, P<0.01). There was no significant difference of measurement of lesion diameter between TTE and ACG in children with VSD and PS (n=36, 18)(P>0.05). The success rate of TTE-guided procedure was 93.3%(28/30) and that of ACG was 96.0%(71/74), showing no significant difference between them (χ2=0.732, P=0.184). There was no evidence that the failure of interventional procedure was related with the choice of imaging guidance. Thirteen of 99 children with successful closure showed small shunts in postoperative angiography and all shunts disappeared in 24 hours. Conclusion    TTE  and ACG have different advantages for different types of CHD intervention; it is necessary to combine both modalities to achieve optimisic diagnostic and therapeutic results.