宫内心脏介入治疗胎儿危重型先天性心脏病5例报告

doi:10.12372/jcp.2024.22e1355

临床儿科杂志 ›› 2024, Vol. 42 ›› Issue (1): 35-39.doi: 10.12372/jcp.2024.22e1355

宫内心脏介入治疗胎儿危重型先天性心脏病5例报告

蔡蕾裔¹, 赵莉晴¹, 王磊², 焦先婷¹, 张拥军³, 武育蓉¹, 朱泓², 夏红萍³, 孙锟¹, 陈笋¹()

1.儿心脏中心，上海交通大学医学院附属新华医院（上海 200092）
2.宫内儿科疾病诊治中心，上海交通大学医学院附属新华医院（上海 200092）
3.新生儿科，上海交通大学医学院附属新华医院（上海 200092）

收稿日期:2022-10-11 出版日期:2024-01-15 发布日期:2024-01-05
通讯作者: 陈笋 E-mail:chensun@xinhuamed.com.cn
基金资助:
上海市卫健委项目(202040160);上海市卫健委项目(20214Y0126)

Fetal cardiac intervention for critical congenital heart disease of fetus: a report of 5 cases

CAI Leiyi¹, ZHAO Liqing¹, WANG Lei², JIAO Xianting¹, ZHANG Yongjun³, WU Yurong¹, ZHU Hong², XIA Hongping³, SUN Kun¹, CHEN Sun¹()

1. Pediatric Heart Center, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
2. Intrauterine Pediatric Disease Diagnosis and Treatment Center, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
3. Neonatology Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China

Received:2022-10-11 Online:2024-01-15 Published:2024-01-05
Contact: CHEN Sun E-mail:chensun@xinhuamed.com.cn

摘要/Abstract

摘要：

目的探索胎儿心脏介入治疗（FCI）对于胎儿危重型先天性心脏病的可行性及短期疗效。方法纳入2018年8月至2022年5月在宫内诊治中心进行FCI的所有患儿的临床资料，包括围产期至出生后基本信息、FCI手术信息、胎儿超声心动图信息等，追踪病例至出生后3月，分析FCI技术的可行性、有效性及安全性。结果纳入胎儿7例，其中5例实施FCI手术，手术成功率100%（5/5），包括2例重度主动脉瓣狭窄（CAS）和3例室间隔完整型肺动脉闭锁（PA/IVS）。手术时的中位孕周为29⁺²（28⁺⁶~32⁺⁴）周。5例胎儿FCI术后的超声心动图指标均获得明显改善。5例胎儿均足月出生，中位出生胎龄39⁺²（38~39⁺⁴）周。生后2例CAS患儿行外科主动脉瓣成形术，3例PA/IVS患儿完成经皮肺动脉瓣球囊扩张术。1例心功能不全CAS患儿于新生儿期死亡，4例随访中，预后良好。结论 FCI是一项安全、有效的技术，有望改善危重型先天性心脏病的预后。

关键词: 胎儿心脏介入治疗, 主动脉瓣狭窄, 室间隔完整型肺动脉闭锁, 先天性心脏病

Abstract:

Objective To explore the feasibility and short-term efficacy of fetal cardiac intervention (FCI) for critical congenital heart disease. Methods The clinical data of all the fetuses who underwent FCI in the intrauterine diagnosis and treatment center from August 2018 to May 2022 were included, including basic information from perinatal to postnatal, FCI surgical information, fetal echocardiogram information, etc., and the fetuses were followed up until 3 months after birth to analyze the feasibility, effectiveness and safety of FCI technology. Results Seven fetuses were included, 5 of whom underwent FCI surgery with a 100% success rate (5/5), including 2 cases of critical aortic stenosis (CAS) and 3 cases of pulmonary atresia with intact ventricular septum (PA/IVS). The median gestational age at the time of FCI surgery was 29⁺²(28⁺⁶-32⁺⁴) weeks. The echocardiographic indexes of 5 fetuses after FCI were significantly improved. All five fetuses were full-term, with a median gestational age of 39⁺²(38-39⁺⁴) weeks. After birth, aortic valvuloplasty was performed in 2 patients with CAS and percutaneous balloon dilatation of pulmonary valve was performed in 3 patients with PA/IVS. One case of CAS with cardiac insufficiency died in the neonatal period, and the other 4 cases had good prognosis during follow-up. Conclusion FCI is a safe and effective technique that is expected to improve the prognosis of critical congenital heart disease.

Key words: fetal cardiac intervention, aortic stenosis, pulmonary atresia with intact ventricular septum, congenital heart disease

蔡蕾裔, 赵莉晴, 王磊, 焦先婷, 张拥军, 武育蓉, 朱泓, 夏红萍, 孙锟, 陈笋. 宫内心脏介入治疗胎儿危重型先天性心脏病5例报告[J]. 临床儿科杂志, 2024, 42(1): 35-39.

CAI Leiyi, ZHAO Liqing, WANG Lei, JIAO Xianting, ZHANG Yongjun, WU Yurong, ZHU Hong, XIA Hongping, SUN Kun, CHEN Sun. Fetal cardiac intervention for critical congenital heart disease of fetus: a report of 5 cases[J]. Journal of Clinical Pediatrics, 2024, 42(1): 35-39.

图/表 3

参考文献 17

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病例	年龄/岁	孕产史	主要诊断	首诊孕周/周	术时孕周/周	出生胎龄/周	出生体重/g	生后结局
例1	35	G3P1	CAS	24⁺⁵	32⁺³	38⁺³	3 980	FU
例2	32	G3P0	CAS	28⁺⁴	28⁺⁶	38⁺⁰	2 710	NND
例3	35	G3P1	PA/IVS	22⁺⁵	32⁺⁴	39⁺⁴	4 160	FU
例4	29	G2P0	PA/IVS	24⁺²	28⁺⁶	39⁺²	3 260	FU
例5	34	G6P0	PA/IVS	26⁺⁰	28⁺³	39⁺³	3 050	FU

宫内心脏介入治疗胎儿危重型先天性心脏病5例报告

Fetal cardiac intervention for critical congenital heart disease of fetus: a report of 5 cases

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