新生兒及嬰兒期危重先心病介入治療

四川大學華西第二醫院心臟介入中心華益民新生兒PBPV近期并發癥：

1、短暫心動過緩、早搏、體循環壓力不能維持；

2、失血（特別是介入治療早期器械原因）；

3、股動脈、靜脈栓塞；

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

5、QTc延長導致室性心動過速。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、原發疾病程度重，機體各項機能處于失代償邊緣；2、主動脈壁損傷，血管夾層，血管破裂；3、心臟穿孔、心包填塞；4、腦血管意外、意識喪失、驚厥；5、原發疾病危重，影響肝素等抗凝劑的代謝，促進DIC出現。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雜型先心病需要BAS的評分系統項目數值分值通過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分需要進行BAS

復雜先心病血氧飽和度越低，體循環血量越不足，以及兩種情況持續時間越長，腦室周圍白質軟化、腦栓塞、腦卒中等腦損傷的發生幾率明顯增加。因而，采用BAS、PDA支架置入等恰當的姑息治療方式來改善體循環的氧合狀態、增加左心系統壓力及血流量對改善復雜先心病的預后及生存質量非常重要。Pre-operativebraininjuryinnewborninfantswithtranspositionofthegreatarteriesoccursatratessimilartoothercomplexcongenitalheartdiseaseandisnotrelatedtoballoonatrial;JAmCollCardiol.2009Balloonatrialseptostomylet'stakeacloserlook.JAmCollCardiol.2009年齡問題：1、在Boston兒童醫院PBAV系列報道中：

1-7天：63例（56%），死亡14例，死亡率22%