“宫内房间隔成形术在治疗胎儿左心发育不全综合征中的疗效”点评 [中文引用][英文引用]

本文有以下几方面临床经验值得借鉴：①宫心房间隔成形术在治疗ＨＬＨＳＩＡＳ 方面虽然手术成功率高，但新生儿成活率却仍比较低，为２８％ ～６９％。而且接受手术的胎儿出生后是否需要复苏及是否需要紧急手术无法预先估计；②手术风险高（２１例手术２胎儿死亡），且可能出现心动过缓、心包积血、胸腔积血等并发症；③手术形成房间隔缺损直径ｍ，胎儿出生后血氧饱和度情况更好，需要进行紧急手术的风险越小；④手术形成较大房间隔缺损的关键在于：①足够大的扩张导管；②球囊穿过房间隔的准确定位；③房间隔缺损在扩张后尽可能小的回缩，房室间隔厚的病例可以考虑放置支架；④手术时机：原则上应该选在左心房高压引起肺血管及肺组织发生继发性改变之前，建议选在２８～３０周。

Objective  Neonates with hypoplastic left heart syndrome and intact or highly restrictive atrial septum have a high rate of mortality. We sought to assess the effect of prenatal intervention intended to create atrial septal defects in fetuses with this diagnosis. Methods  We reviewed the medical records and imaging of all fetuses undergoing intervention for atrial septal defect creation in the setting of hypoplastic left heart syndrome and intact atrial septum. The procedures were performed with a percutaneous cardiac puncture under the guidance of ultrasonography. For the 21 interventions, patient and procedural characteristics were analyzed to identify predictors of neonatal outcome. Results  Of 21 procedures attempted between 24 and 34 weeks’ gestation, 19 were technicaly successful. Fetal demise occurred in two cases. The size of the created defect variedand measured at least 3 mm in six fetuses. Among 19 neonates, a larger atrial septal defect was associated with higher oxygen saturation and less need for intervention prior to surgical single-ventricle paliation. Conclusion  Technicaly successful atrial septal defect creation in fetuses with hypoplastic left heart syndrome and intact atrial septum results in atrial septal defects of varying size; defects of at least 3mm in diameter appear to benefit.