第一部分  复杂先天性心脏病外科术后异常静脉的介入治疗

                                         摘要

目的：在复杂先天性心脏病（CCHD）的矫治或姑息性手术中，许多患者可能无法耐受术后血流动力学的突然变化，从而导致严重不良事 件的发生。为了改善预后，某些异常静脉被有意地保持开放，使其作为“减压通道”，防止术后出现肺动脉高压危象，优化血流动力学，并有助于心脏适应新的工作负荷。然而，异常静脉的长期存在也会导致血流动力学紊乱，需要对其进行再次开胸手术结扎，而经导管介入闭合可以避免再次开胸手术给患者带来的创伤。本研究旨在评估CCHD患者外科术后异常静脉介入治疗的安全性及有效性。

方法：回顾性分析2007年12月至2019年9月阜外医院15例CCHD患者外科术后异常静脉（奇静脉、半奇静脉、垂直静脉）经导管闭合的临床资料，比较患者异常静脉封堵前后股动脉血氧饱和度（S_FAO₂%）及血流动力学的变化，以评估封堵效果并随访其疗效。

结果：所有异常静脉均封堵成功。奇静脉或半奇静脉封堵后S_FAO₂%较封堵前明显升高（86.94±2.63% VS 74.98±3.53%，P<0.001, 差值：11.96，95%CI：9.63-14.29)。封堵后平均肺动脉压（mPAP）较封堵前升高，但均在正常值范围内（12.08±2.75mmHg VS 10.54±3.28mmHg ，P=0.020，差值：1.54，95%CI：0.29-2.79)。封堵前后上腔静脉压（SVCP）几乎没有变化（11.08±3.62 VS 12.31±3.25，P=0.059，差值：1.23，95%CI：-0.05-2.52)。垂直静脉封堵后S_FAO₂%较封堵前明显升高（ 98% VS 86%; 99% VS 88%）。封堵后右心室舒张末期内径 (33mm VS 37mm; 18mm VS 26mm)及右心室/左心室舒张末期内径 (0.78 VS 0.90； 0.47 VS 0.70)显著减少，表明右心室前负荷显著减轻。在平均26.33±13.94月的随访中，所有患者的病情平稳，无严重不良事件的发生。

结论：CCHD患者外科术后异常静脉的介入治疗是一种安全有效的方案，可提高动脉血氧饱和度、减轻紫绀和改善心功能，并且具有很高的技术成功率和良好的短期和中期预后，可避免二次开胸手术给患者带来的身心创伤。

         第二部分  复杂先天性心脏病Fontan术后开窗的介入治疗

                                      摘要

目的：在功能性单心室生理矫治的Fontan手术中，为避免术后出现肺动脉高压危象，Fontan循环衰竭，术中常加行外管道开窗术，以降低肺动脉压及中心静脉压，增加心输出量，从而维持Fontan循环的稳定。然而，长期的开窗分流也会导致血氧饱和度降低、反常栓塞的风险增加，需要将其闭合。为了避免重复开胸手术给患者带来的创伤，本研究旨在评估复杂先天性心脏病（CCHD）患者Fontan术后开窗介入治疗的安全性及有效性。

方法：回顾性分析2007年7月到2020年10月阜外医院13例CCHD 患者Fontan术后开窗经导管闭合的临床资料，比较患者开窗封堵前后股动脉血氧饱和度（S_FAO₂%）及血流动力学的变化，以评估封堵效果并随访其疗效。

结果：所有开窗均封堵成功。封堵器部署后所有开窗均完全闭塞，无明显残余分流。外管道开窗封堵后S_FAO₂%较封堵前明显升高，差异有统计学意义（97.03±1.94% VS 85.15±3.46%，P<0.001,差值：11.88%，95%CI：8.97-14.78)。封堵前、后肺动脉收缩压（sPAP）、肺动脉舒张压（dPAP）、平均肺动脉压（mPAP）、外管道压无明显变化。在平均22.15±2.99月的随访中，所有患者的病情均较平稳，无严重不良事件的发生。

结论：CCHD患者Fontan术后开窗的介入治疗疗效确切，方法可行，可增加肺动脉血流量，提高动脉血氧饱和度、减轻心脏负荷和患者紫绀，并且具有很高的技术成功率和良好的短期和中期预后，可避免二次开胸手术给患者带来的身心创伤。

第三部分（综述） 介入治疗在复杂先天性心脏病外科术后残余病变中的应用

摘要：复杂先天性先天性心脏病（CCHD）矫治术后残余病变往往需要外科手术或者介入治疗。外科手术往往需要开胸、体外循环、全身麻醉，不仅创伤大、风险高、术后恢复慢及瘢痕明显，而且由于首次术后心包和周围组织粘连，再次手术的难度也明显增加。然而，介入治疗具有微创、高效、并发症少、可重复性强、能达到手术野不易到达的部位等优点，使其成为外科手术的一种较理想的替代方案。本文对介入治疗在CCHD外科术后残余病变中的应用进行综述，以期为临床上对这类疾病的处理提供新的思路。

                                    Abstract（I)

The interventional treatment of abnormal veins after surgery for complex congenital heart disease

Objective: In corrective or palliative surgery for complex congenital heart disease (CCHD), many patients may not tolerate sudden changes in hemodynamics postoperatively, leading to severe adverse events. To improve outcomes, anomalous veins with residual shunts are intentionally left open to serve as a “decompression channel,” preventing postoperative pulmonary arterial hypertension crises, optimizing hemodynamics, and aiding the heart in adapting to its new workload. However, the long-term presence of these anomalous veins can also cause hemodynamic disturbances, necessitating surgical ligation or interventional closure. To avoid the trauma associated with repeat thoracotomy for patients, this study aims to evaluate the safety and efficacy of interventional treatment for anomalous veins following surgery in CCHD patients.

Methods: A retrospective analysis was conducted on the clinical data of 15 patients with CCHD who underwent transcatheter closure of anomalous veins (azygos, hemiazygos, and vertical veins) after surgical intervention at Fuwai Hospital between December 2007 and September 2019. The study compared the femoral artery oxygen saturation (S_FAO₂%) and hemodynamic changes before and after the occlusion of the anomalous veins to assess the effectiveness of the procedure and to follow up on the therapeutic outcomes.

Results: All anomalous veins were successfully closed. After the closure of the azygos or hemiazygos veins, the S_FAO₂% significantly increased compared to pre-closure levels (86.94±2.63% vs. 74.98±3.53%, P<0.001, D: 11.96, 95% CI: 9.63-14.29). The mean pulmonary artery pressure (mPAP) increased after closure but remained within normal limits (12.08±2.75 mmHg vs. 10.54±3.28 mmHg, P=0.020, D: 1.54, 95% CI: 0.29-2.79). There was almost no change in the superior vena cava pressure (SVCP) before and after closure (11.08±3.62 vs. 12.31±3.25, P=0.059, D: 1.23, 95% CI: -0.05-2.52). For the vertical vein closure cases, the S_FAO₂% significantly increased after closure (Case 14: 98% vs. 86%; Case 15: 99% vs. 88%). Following the closure, there was a significant reduction in the right ventricular end-diastolic diameter（RV）(Case 14: 33mm vs 37mm; Case 15: 18mm vs 26mm), indicating a significant decrease in the right ventricular preload. During an average follow-up period of 26.33±13.94 months, all patients remained stable without any occurrence of serious adverse events.

Conclusion: Transcatheter closure of anomalous veins following surgery in CCHD patients is a safe and effective approach that can enhance arterial oxygen saturation, alleviate cyanosis, and improve cardiac function. This method demonstrates high technical success rates and favorable short- and mid-term outcomes, avoiding the physical and psychological trauma associated with secondary thoracotomy for patients.

                                      Abstract(II)

The interventional treatment of fenestration after Fontan surgery for complex congenital heart disease

Objective：In the Fontan surgery for functional single ventricle physiology correction, to prevent postoperative pulmonary hypertension crisis and Fontan circulation failure, an extracardiac conduit fenestration is often performed during the operation. This procedure helps to reduce pulmonary artery pressure and central venous pressure, and increase cardiac output, thereby maintaining the stability of the Fontan circulation. However, long-term fenestration shunting can also lead to decreased blood oxygen saturation and increased risk of paradoxical embolism, necessitating its closure. To avoid the trauma caused by repeat thoracotomy to the patient, this study aims to evaluate the safety and efficacy of interventional treatment for fenestration closure after Fontan surgery in patients with complex congenital heart disease (CCHD).

Method：A retrospective analysis was conducted on the clinical data of 13 patients with CCHD who underwent transcatheter closure of fenestration after Fontan surgery at Fuwai Hospital from July 2007 to October 2020. The study compared the femoral arterial oxygen saturation (S_FAO₂%) and hemodynamic changes before and after fenestration occlusion to assess the effectiveness of the closure and to follow up on its therapeutic outcomes.

Results：All fenestrations were successfully occluded. After the deployment of the occluder, all fenestrations were completely closed with no significant residual shunt. The SFAO2% significantly increased after the occlusion of the extracardiac conduit fenestration compared to before the occlusion, with a statistically significant difference (97.03±1.94% vs 85.15±3.46%, P<0.001, difference: 11.88%, 95% CI: 8.97-14.78). There was no significant change in systolic pulmonary artery pressure (sPAP), diastolic pulmonary artery pressure (dPAP), mean pulmonary artery pressure (mPAP), or the pressure in the extracardiac conduit before and after the occlusion. During an average follow-up of 22.15±2.99 months, all patients remained stable with no occurrence of serious adverse events.

Conclusion：Interventional therapy for fenestration in CCHD patients after Fontan surgery has proven to be effective and feasible. It can increase pulmonary blood flow, improve arterial oxygen saturation, reduce cardiac load and patient cyanosis. This method boasts a high technical success rate and favorable short-term and mid-term prognosis, avoiding the physical and psychological trauma associated with secondary thoracotomy for patients.

                                  Abstract(III)

Application of Interventional Treatment in Residual Lesions Following Surgery for Complex Congenital Heart Disease

     Residual lesions following corrective surgery for Complex Congenital Heart Disease (CCHD) often require either surgical intervention or interventional treatment. Surgical procedures typically necessitate thoracotomy, cardiopulmonary bypass, and general anesthesia, which not only result in significant trauma, high risk, slow postoperative recovery, and noticeable scarring but also increase the difficulty of subsequent surgeries due to adhesions of the pericardium and surrounding tissues after the initial operation. In contrast, interventional treatments offer minimally invasive, highly efficient, low-complication, and repeatable options that can reach areas difficult to access through traditional surgical fields. These advantages make interventional treatment an ideal alternative to surgical procedures. This paper reviews the application of interventional treatment in managing residual lesions following CCHD surgery, aiming to provide new perspectives for clinical management of such conditions.