Objective:To summarize and explore the role and application experience of emergency interventional therapy in the postoperative treatment of complex congenital heart disease.Methods:Data of patients(age＜18 years)with post-operation emergency interventional treatment in complex congenital heart disease between January 2013 and May 2023 was retrospectively collected.SPSS 25.0 was used to analyze the baseline data,clinical characteristics before and after collateral occlusion,distribution,management,and clinical outcomes of collateral branches after surgery.Results:A total of 12 cases were included,with 8 males(66.7％)and 4 females(33.3％).At the time of surgery,the age was 48(7.5,93)months and the weight was 13(6.9,31.1)kg.Among these patients,10 patients were undergone preoperative imaging examination or therapy,of which 6 patients were treated by transcatheter embolization of the pulmonary collateral,while the other 4 patients without obvious pulmonary collaterals were not intervened.All children underwent surgical correction,among whom 7 cases had increased blood return,and 2 cases underwent ligation of the aortopulmonary collateral arteries during surgery.All children had at least one of the following symptoms after surgery:(1)with various degrees of pulmonary hemorrhage or bloody sputum,(2)requiring higher-condition ventilator support,with high end-tidal airway pressure;(3)pulmonary image changes(chest radiograph suggests pulmonary blood flow,pulmonary exudation,or patchy shadow);(4)intolerance to ventilator withdrawal.(5)accompanied by cardiac insufficiency and unsatisfactory maintenance of blood oxygen saturation.A total of 29 aortopulmonary collateral arteries in all patients were emergently occluded on an average of 4.5(3.0,13.0)days after surgical correction,with an average of 2.42 collateral vessels per child.The sources of the collateral arteries were mainly from the thoracic aorta(8 cases,66.7％),the brachiocephalic arteries(8 cases,66.7％),and the abdominal aorta(2 cases,16.7％).Ten patients'condition improved after the occlusion by being weaned from the ventilator on the interval of(55.8±30.4)hours,with the circulation getting stable,the heart function being improved,and in the end they were discharged smoothly.The other 2 cases had poor prognosis due to the simultaneous presence of other complex conditions.Conclusions:As one of the diagnostic and therapeutic challenges for children with complex congenital heart disease and diminished pulmonary blood,the variable aortopulmonary collateral arteries are recommended to be early detected and intervened before and during surgery.However,timely emergency intervention post-operation has also been proved to be served as an effective remedial measure to reduce perioperative complications,as well as to improve perioperative prognosis.
关键词
先天性心脏病/介入治疗/体肺侧枝/心脏外科手术
Key words
Congenital heart disease/Interventional therapy/Aortopulmonary collateral artery/Cardiac Surgery
维普
万方数据