Abstract：
OBJECTIVE: Pulmonary atresia with intact ventricular septum and critical pulmonary stenosis usually have to undergo treatment in the neonatal period. Compared to traditional surgical intervention, catheter-based cardiac interventions may achieve similar or superior outcomes for neonates with pulmonary atresia with intact ventricular septum and critical pulmonary stenosis. However, there is limited literature on anaesthesia techniques, challenges, and risks associated with cardiac catheterisation in this population.
METHODS: This article retrospectively analysed the clinical data of pulmonary atresia with intact ventricular septum and critical pulmonary stenosis neonates who were treated with interventional cardiac catheterisation in our hospital from January 2015 to October 2022. Clinical outcomes considered were haemodynamic or pulse oxygen saturation instability, vasoactive requirements, prolonged intubation (>24 h postoperatively), and cardiovascular adverse events.
RESULTS: A total of 63 patients met the inclusion criteria. All patients survived the intervention. Among the patients with critical pulmonary stenosis, 40 successfully received percutaneous balloon pulmonary valvuloplasty, while three patients received ductal stenting due to moderate right ventricular dysplasia at the same time. For patients with pulmonary atresia with intact ventricular septum, 17 of the 23 patients successfully underwent percutaneous pulmonary valve perforation and percutaneous balloon pulmonary valvuloplasty. Of these, five patients underwent ductal stenting due to unstable pulmonary blood flow. Three patients only underwent ductal stenting. In addition, three patients received hybrid therapy.
CONCLUSIONS: There are various clinical techniques and risk challenges in the interventional cardiac catheterisation of neonatal pulmonary atresia with intact ventricular septum and critical pulmonary stenosis. However, by mastering the physiological and pathophysiological characteristics of the disease, adequately preparing for the perioperative period, and predicting the procedure process and potential complications, anaesthesia and surgical risks can be effectively managed.
METHODS: This article retrospectively analysed the clinical data of pulmonary atresia with intact ventricular septum and critical pulmonary stenosis neonates who were treated with interventional cardiac catheterisation in our hospital from January 2015 to October 2022. Clinical outcomes considered were haemodynamic or pulse oxygen saturation instability, vasoactive requirements, prolonged intubation (>24 h postoperatively), and cardiovascular adverse events.
RESULTS: A total of 63 patients met the inclusion criteria. All patients survived the intervention. Among the patients with critical pulmonary stenosis, 40 successfully received percutaneous balloon pulmonary valvuloplasty, while three patients received ductal stenting due to moderate right ventricular dysplasia at the same time. For patients with pulmonary atresia with intact ventricular septum, 17 of the 23 patients successfully underwent percutaneous pulmonary valve perforation and percutaneous balloon pulmonary valvuloplasty. Of these, five patients underwent ductal stenting due to unstable pulmonary blood flow. Three patients only underwent ductal stenting. In addition, three patients received hybrid therapy.
CONCLUSIONS: There are various clinical techniques and risk challenges in the interventional cardiac catheterisation of neonatal pulmonary atresia with intact ventricular septum and critical pulmonary stenosis. However, by mastering the physiological and pathophysiological characteristics of the disease, adequately preparing for the perioperative period, and predicting the procedure process and potential complications, anaesthesia and surgical risks can be effectively managed.
摘要：
目的：室间隔完整的肺动脉闭锁和严重的肺动脉狭窄通常在新生儿期需要接受治疗。与传统的外科手术相比，对于室间隔完整和严重肺动脉瓣狭窄的肺动脉闭锁新生儿,基于导管的心脏介入治疗可能取得相似或更优的结局.然而,关于麻醉技术的文献有限，挑战,以及该人群中与心脏导管插入相关的风险。
方法：回顾性分析2015年1月至2022年10月在我院行介入心导管术治疗的室间隔完整的肺动脉闭锁和危重肺动脉瓣狭窄新生儿的临床资料。考虑的临床结果是血流动力学或脉搏氧饱和度不稳定，血管活性要求，长时间插管（术后>24小时），和心血管不良事件。
结果：共有63例患者符合纳入标准。所有患者均在干预后存活。在危重的肺动脉狭窄患者中，40例成功接受经皮球囊肺动脉瓣成形术,3例患者同时因中度右心室发育不良而接受导管支架置入术。对于室间隔完整的肺动脉闭锁患者，23例患者中有17例成功接受了经皮肺动脉瓣穿孔和经皮球囊肺动脉瓣成形术。其中,5例患者因肺血流不稳定而接受导管支架置入术.三名患者仅接受导管支架置入术。此外,3例患者接受混合治疗.
结论：新生儿肺动脉闭锁伴室间隔完整和严重肺动脉瓣狭窄的介入心导管插入术存在多种临床技术和风险挑战。然而,通过掌握疾病的生理和病理生理特征，为围手术期做好充分准备，并预测手术过程和潜在的并发症，麻醉和手术风险可以得到有效管理。
方法：回顾性分析2015年1月至2022年10月在我院行介入心导管术治疗的室间隔完整的肺动脉闭锁和危重肺动脉瓣狭窄新生儿的临床资料。考虑的临床结果是血流动力学或脉搏氧饱和度不稳定，血管活性要求，长时间插管（术后>24小时），和心血管不良事件。
结果：共有63例患者符合纳入标准。所有患者均在干预后存活。在危重的肺动脉狭窄患者中，40例成功接受经皮球囊肺动脉瓣成形术,3例患者同时因中度右心室发育不良而接受导管支架置入术。对于室间隔完整的肺动脉闭锁患者，23例患者中有17例成功接受了经皮肺动脉瓣穿孔和经皮球囊肺动脉瓣成形术。其中,5例患者因肺血流不稳定而接受导管支架置入术.三名患者仅接受导管支架置入术。此外,3例患者接受混合治疗.
结论：新生儿肺动脉闭锁伴室间隔完整和严重肺动脉瓣狭窄的介入心导管插入术存在多种临床技术和风险挑战。然而,通过掌握疾病的生理和病理生理特征，为围手术期做好充分准备，并预测手术过程和潜在的并发症，麻醉和手术风险可以得到有效管理。
