摘要
目的 探讨Ⅰ型和Ⅱ型永存动脉干的治疗效果.方法 回顾分析2010年1月至2016年5月在我院接受外科治疗的10例永存动脉干患者的资料.其中Ⅰ型共同动脉干6例、Ⅱ型永存动脉干4例;年龄1～14（6.5±4.2）个月;合并房间隔缺损、共同动脉瓣关闭不全、主动脉弓缩窄、三尖瓣关闭不全.1例1岁2个月的患儿术前行右心导管检查测得肺血管阻力4.5 WOOD.U.所有患者都行一期手术根治术.右心室-肺动脉流出道重建,6例采用牛颈静脉带瓣管道,4例采用Gortex人工管道重建右室流出道.结果 手术早期死亡1例,死亡率为10％（1/10）.生存9例,晚期死亡1例.死亡的1例为术前合并主动脉弓缩窄,术中深低温、停循环,术后出现多器官功能衰竭死亡.术后早期出现严重肺动脉高压危象3例,治疗后循环稳定.余患儿顺利恢复出院.出院时心脏超声提示肺动脉反流4例,2例轻-中度,2例中度.术后9例随访3个月至6年,平均60个月,1例术后半年猝死.结论 严格把握手术指征,术前充分评估肺血管病变、注意冠状动脉起源异常、妥善的共同瓣膜修复、右室流出道管道的选择等,是Ⅰ型和Ⅱ型永存动脉干早期甚至新生儿期进行一期手术治疗近、中期效果满意的关键.
Objective To investigate the therapeutic effect of I and Ⅱ type persistent truncus arteriosus in our hospital in the past 6 years, and to improve the clinical therapeutic effect. Methods The data of l0 pa- tients who received surgical treatment in our hospital from January 2010 to May 2016 were analyzed retrospec- tively. Among them, type I common artery trunk was 6 cases, Ⅱ type permanent arterial trunk in 4 cases. Age 1-14（6.5±4.2）months. Combined with atrial septal defect, common aortic valve insufficiency, aortic arch constric- tion, three-point valve closure was not complete. At the age of 14 months 1 cases of children underwent right heart catheterization measured pulmonary vascular resistance 4.5 WOOD.U. All patients will do a radical operation. Right ventricular pulmonary outflow tract reconstruction, 6 cases of the use of bovine jugular vein conduit, 4 cases with Cortex artificial pipe fight ventricular outflow tract reconstruction. Results 1 case died, the mortality rate was 10%（1/10）, 9 cases survived and 1 case died in the late stage. 1 case died for preoperative with coarctation of the aorta, with deep hypothermia, circulatory arrest and postoperative appear multiple organ function failure death. Early postoperative crisis severe pulmonary hypertension in 3 cases, after the treatment of stable circulation. 1 recovered and discharged from hospital. At the time of discharge, 4 cases of pulmonary artery regurgitation, 2 cases of mild to moderate, 2 cases with moderate. 9 cases were followed up for 3 months to 6 years, with an aver- age of 60 months, and 1 case of sudden death after surgery. Conclusion Strictly grasp the indications for surgery, preoperative fully assess the pulmonary vascular lesions, pay attention to coronary anomalous origin and proper common valve repair and right ventricular outflow pipeline etc., type I and type Ⅱ persistent truncus ar- teriosus early even in the neonatal period of one stage surgical treatment of recent and mid-term results were satis- factory.
出处
《中国心血管病研究》
CAS
2017年第1期42-44,共3页
Chinese Journal of Cardiovascular Research
关键词
先天性心脏病
永存动脉干
外科手术治疗
Congenital heart disease
Persistent arterial trunk
Surgical treatment
