https://scholars.lib.ntu.edu.tw/handle/123456789/194406
標題: | 經由主動脈至肺動脈分流管以氣球導管擴張肺動脈瓣膜閉鎖病人之肺動脈狹窄之效果評估 | 作者: | 王主科 | 關鍵字: | 分流管;肺動脈狹窄;PTFE 管;modified systemicpulmonary ar tery shunt;pulmonary ar tery stenosis;balloon angioplasty;polytetrafluoroethylene (PTFE) tube | 公開日期: | 2000 | 出版社: | 臺北市:國立臺灣大學醫學院小兒科 | 摘要: | 合併肺動脈閉鎖之先天性心臟病人常 需接受分流手術,所放置的分流管(Goretex tube)常發生阻塞或造成肺動脈變形。過寺 都需再接第二次分流管,我們利用氣球導 管擴張術,治療分流管的狹窄。從1994 年 至1999 年間,以氣球擴張術治療46 例患 有分流管阻塞的病人,擴張結果在42 例 (91%)明顯有效。其中有28 條肺動脈狹窄, 我們順便擴張其中25 條肺動脈,14 條擴張 成功。血中氧氣濃度由74.4 ±4.3%升高為 80.8 ±3.6%,後來有8 例需接受第二次分 流管手術,經追蹤11.6 ±5.4 月後,29 病 人接受另一次心血管攝影之後26 例開刀治 療,僅有2 例死亡。結論:當病人分流管阻 塞而考慮放置第二條分流管時,氣球導管 擴張術是個代替開刀的方式。 Objectives. The results of percutaneous balloon angioplasty for obstructed modified Blalock-Taussig (BT) or central shunts and pulmonary artery stenoses were studied to assess its role as an alternative to second shunt and surgical pulmonary artery angioplasty. Background. Obstruction of a modified shunt and pulmonary artery stenosis related to the shunt or ductus is not infrequent. A second shunt with or without pulmonary artery angioplasty is required if the pulmonary artery size, morphology or age of the patient is suboptimal for definitive surgery. Methods. From June 1994 to May 1999, balloon angioplasty for obstructed systemicto- pulmonary artery shunts was performed in 46 patients, with ages ranging from 1 month to 7.4 years (2.2±1.9 years). Among the 46 patients, 32 had a modified BT shunt, 5 had bilateral shunts, 7 had a modified central shunt and 2 had both modified BT and central shunt. Stenoses were seen in 27 main branch pulmonary arteries and interruption was present in 3. A concurrent balloon angioplasty was attempted in 28 main branch pulmonary arteries, but performed in 25 vessels. Results. Balloon dilation for obstructed modified shunts was considered to be effective in 42 patients (91%), while angioplasty for pulmonary artery stenosis was effective in 14 vessels, and non-effective in 11 vessels. After balloon dilatation angioplasty, oxygen saturation in the aorta increased from 74.4+4.3% to 80.8+3.6% (P<0.01) in these 42 patients. One patient died of pneumonia. Eight patients required an additional modified BT shunt soon after the procedure because of severe stenosis or interruption at main branch pulmonary artery. After a mean follow-up period of 11.6±5.4 months, 29 patients underwent a repeated imaging study to evaluate the morphology and size of the pulmonary arteries. Of these 29 patients, 26 underwent open heart surgery with 2 mortalities. Conclusions. When a second shunt is under consideration because of obstruction of the modified shunt, balloon angioplasty is a possible alternative procedure. Pulmonary artery stenosis, if present, can be simultaneously dilated. |
URI: | http://ntur.lib.ntu.edu.tw//handle/246246/22841 | 其他識別: | 892314B002038 | Rights: | 國立臺灣大學醫學院小兒科 |
顯示於: | 醫學系 |
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892314B002038.pdf | 74.03 kB | Adobe PDF | 檢視/開啟 |
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