Clinical Effect Of Postoperative Interventional Therapy For Pulmonary Hypopnea Complicated Congenital Heart Disease

Background:Decreased pulmonary blood type of complex congenital heartdisease accounted for11.5%of congenital heart disease,and It is a difficult treatmentto cardiac surgery.Merging pulmonary hypoplasia or pulmonary valve of severestenosis of pulmonary blood type to reduce complex congenital heart disease of pul-monary blood supply to the pul-monary blood flow, rely on very little ahead of ische-mia hypoxia serious, could be life threatening.Many children need to have a B-Tshunt or Glenn surgery and other palliative surgery increased pulmonary blood firstly,relieve symptoms of hypoxia,pulmonary vascular bed and improve ventricular func-tion, in order to achieve effect a radical cure treatments or physiological condi-tion.However,some patients due to shunt stenosis resulting in longer follow-up timeof hypoxemia, poor pulmonary vascular development, fail to cure the condition,orneed a secondary shunt surgery, increasing the risk of surgery.How to further improvethese patients’ pulmonary vascular development and increase the chance of cure of thepatient is the direction of research efforts in recent years,both in domestic and foreignscholars. This study intends to reduce pulmonary blood type of complex congenitalheart disease,which had a palliative surgery，follow-up evalua-tionis still hard toreach patients undergoing radical conditions, the implemen-tation of the pulmonaryartery balloon angioplasty to clear its presurgical palliative surgery patients through adirect increase on the basis of medical inter-ventions forward pulmonary blood flowand promote their pulmonary vascular development,improve the clinical effect ofbiventricular function.Method：Collected decreased pulmonary blood type of complex congenital heartdisease from July2012to December2013who had a palliative surgery one year afterradical pulmonary development but yet not to reach the required total of15cases ofpatients.Which have9males and6females, age:4.8(1.0~13.0)years, weight:20.3(11.0~48.0) kg,height:100.2(74.0~173.0) cm. Into the group of patients beforesurgery routine echo car-diography, electrocardiogram,chest X-ray,cardiac catheteriza-tion and angiography in all cases passing through the pulmonary valve or pulmonary balloon dilatation,After1month,3months,6months,1year followup, includingechocardiography,chest X-ray, ECG,clinical evaluation of car-diac function, ifnecessary,need to have cardiac catheterization and angiography examination. Evaluation for the treatment of percutaneous balloon pulmonary lung blood type to reducepostoperative pulmonary artery complex congenital heart disease palliation develo-pment is still not up to effect a radical cure conditions of the patient’s clinical effect.Statistical Methods:Data using Excel and SPSS18.0statistical software foranalysis.; Normal continuous distribution data described using the mean plus or minusstandard deviation(x±s); Non-normal contin-uous data using the median andinterquartile description;discrete data with the rate description.Two samples werecompared using paired t test, P <0.05was considered statistically significant.Results:All patients were successfully carried out medical intervention, Except onecase occurs oxygen saturation、heart rate and blood pressure reducing when in theintraoperative pulmonary valve balloon dilatation and then giving immditelywethddraw the balloon,and giving to symptomatic treatment such as oxygen,boost,andenhance heart rate,after the vital signs stabilized,then giving reduced the balloon’sdiameter and had a success balloon dalatation again；and one case occurs rhythmiaand intermittent premature ventricular contractions,when the balloon expan-ding,we give a close monitoring of ECG, blood pressure and blood oxygen conditions,without treatment,and then the rhythmia and intermittent premature ventricularcontractions disappeared after12hours.the rest of children with no intraoperative andpostoperative complications，eleven of whom underwent pulmonary valve balloondilatation，4cases of pulmonary branch balloon angio-plasty.One case exists III°AVBgiven pacemaker implantation when undergoing intervention surgery,one case made aroutine review of the pulmonary artery balloon after three months found thebeginning part of the left pulmonary artery still stenosis and then gived a leftpulmonary artey balloon dilation. Efficacy of immediate postoperative view:15casesof children immediately after right heart catheterization and angiography data showthat PTG、RVSP and SaO2have a significant change Compared with the preoperative. The difference was statistically significant(P <0.05).Before pulmonary valve surgery,intra operative and postoperative24hours and have no significant changes in internaldiameter,the difference was not statistically significant(P>0.05). Consider thepossibility of postoperative pulmonary valveor pulmonary edema.Mean follow-uptime of3.58±2.82months during followup echocardiography or CT pulmonary valvewas found in children,there are significant differences(P <0.05)before the mainpulmonary artery,left and right pulmonary artery, Nakata index, Mcgoon ratio, PTGand other than surgery.Four people respectively within40days after the balloonexpansion, may, July, and1year, better to effect a radical cure for pulmonarydevelopment standard and the final line of radical surgery,Two cases of applicationsacross the ring patch,postoperatively with stable vital signs, cardiac function andtranscutaneous oxygen saturation were in the normal range,bruising significantimprovement over the previous activity levels have improved significantly.the rest ofchildren are still in followup, smooth condition, purple purple reduced from theprevious, the X-ray lung blood tolerance increased earlier and activities, all childrenwith cardiac function grading classification (New York grade)compared withpreoperative average increase in Class I, oxygen saturation remained at around88%(no oxygen state).Conclusion: Percutaneous pulmonary artery balloon dilatation of the pulmonaryartery to reduce complex congenital heart disease surgery post-operative patients withinterventional therapy can effectively increase the tolerance to pulmonary blood flow，Promote the pulmonary vascular development，further improvement of ventricularfunction in favor of radical treatment，Shows a clear clinical effect.At the same timereduce the surgical risk of secondary thoracotomy and complications, reduce medicalcosts, compared with the surgical palliative operation shows its unique advantages.