Objective To investigate the value of transesophageal echocardiography ( TEE) in off-pump hybird therapy of transthoracic balloon pulmonary valvuloplasty for pulmonary atresia with intact ventricular septum infant, and to summarize the key points of the operation. Methods 13 patients of pulmonary atresia with intact ventricular septum under went hybrid therapy of transthoracic balloon pulmonary valvuloplasty guided by TEE were retrospectively analyzed. All of them were performed with a median sternotomy. A purse-string suture was placed in the right ventricular outflow tract 2 cm away from the pulmonary trunk, and then a guide wire and a puncture sheath pipe were inserted with the guidance of TEE. The open situations of pulmonary valves and the across valve pressures were observed by TEE after sequential dilations. Results 13 patients for balloon valvuloplasty were all successfully performed with the guidance of TEE, no severe complications occurred in all patients, the antegrade flow velocity of the postoperative pulmonary valves were all less than 3 m/s, the gradient pressures were less than 36 mm Hg(l mm Hg=0. 133 kPa). 1 patient abandoned treatment for serious infection, other patients had no restenosis followed up at 6 months to 2 years after operation. Conclusions The hybird therapy of transthoracic balloon pulmonary valvuloplasty guided by TEE for infant pulmonary atresia with intact ventricular septum is a safe and effective approach, which may produce less trauma and complications, significantly reduce the risk and increase the successful rate.%目的 研究经食管超声心动图(TEE)在婴幼儿室间隔完整型肺动脉闭锁(PA/IVS)非体外循环下经胸肺动脉瓣球囊扩张镶嵌治疗中的应用,评价其临床价值,总结操作要点.方法 回顾性分析13例利用TEE引导经胸肺动脉瓣球囊扩张成形术治疗PA/IVS的镶嵌治疗,所有患儿均胸骨正中切口,于右室流出道距离肺动脉瓣环下约2 cm缝荷包线,在TEE引导下置入导丝和穿刺鞘管.确认穿刺针对准膜性闭锁的瓣膜后,在钢丝引导下放入球囊扩张管进行扩张,TEE观察肺动脉瓣开放情况,测量跨瓣压差.结果 TEE引导下,13例球囊扩张成形术均成功完成,所有患儿均未出现严重并发症,扩张后的肺动脉瓣正向血流速度均小于3 m/s,压差均小于36 mm Hg(1 mm Hg=0.133 kPa).术后除1例患儿因重症感染放弃治疗外,其余患儿随访6个月～2年,无再狭窄发生.结论 TEE辅助下,经胸肺动脉瓣扩张成形镶嵌技术治疗婴幼儿PA/IVS是安全、有效的方法,可消除常规外科手术体外循环对于心脏的创伤,避免导管产生并发症,大大降低手术的风险性,提高手术成功率.
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