摘要
目的:回顾总结先天性主动脉弓中断(IAA)合并主动脉肺动脉窗(APW)一期手术治疗经验。方法:2009-01至2016-08,选取我院手术治疗IAA合并APW患者8例,男性4例,手术年龄3个月~4.5岁。其中<1岁者6例,平均年龄(5.2±2.7)个月,平均体重(5.7±1.6)kg;>1岁者2例,平均年龄(4.1±0.6)岁,平均体重(14.6±0.9)kg。所有患者术前均有反复呼吸道感染史。IAA分型:A型6例,B型2例;APW分型Ⅱ型6例,Ⅲ型2例。8例均采用胸正中切口,深低温停循环选择性脑灌注,一期同时纠治IAA和APW及合并畸形。结果:8例患者术前肺动脉收缩压平均值(83.1±8.3)mmHg(1mmHg=0.133 kPa);术中体外循环时间(127.0±18.5)min,主动脉阻断平均时间(78.0±14.1)min;术后肺动脉收缩压平均值(43.6±8.5)mmHg;全组无手术死亡。随访平均(19.8±13.9)个月,主动脉弓部压力阶差平均(11.2±4.7)mmHg,均恢复良好。结论:IAA合并APW采用一期手术可以彻底矫治,采用胸正中切口方法,操作简便,手术效果良好。
Objective： To retrospectively summarize the clinical experience of one-stage repair and surgical management in patients with interrupted aortic arch （IAA） combining aortopulmonary window （APW）. Methods： A total of 8 patients with IAA combining APW received surgical repair in our hospital from 2009-01 to 2016-08 were enrolled including 4 male, the age at operation was between 3 months to 4.5 years. There were 6 patients〈1 year at the mean age of （5.2±2.7） months with the mean body weight at （5.7±1.6） kg; 2 patients〉1 year at the mean age of （4.1±0.6） years with the mean body weight at （14.6±0.9） kg. All patients had the history of repeated respiratory infection before the operation. The IAA morphology included type A in 6 patients and type B in 2; APW morphology included type II in 6 patients and type III in 2. All patients received median sternotomy with deep hypothermic circulatory arrest and antegrade selective cerebral perfusion. The malformation of IAA combining APW was corrected by one-stage operation. Results： The mean pre-operative pulmonary artery systolic pressure （PASP） was （83.1±8.3） mmHg, mean cardiopulmonary bypass time was （127.0±18.5） min, aortic cross-clamp time was （78.0±14.1） min; the mean post-operative PASP was （43.6±8.5） mmHg, no operative death occurred. The patients were followed-up for （19.8±13.9） months and the mean aortic arch pressure gradient was （11.2±4.7） mmHg, all patients were well recovered. Conclusion： Primary anatomical IAA combining APW can be thoroughly corrected by one-stage operation; median sternotomy was simple method with good effect.
出处
《中国循环杂志》
CSCD
北大核心
2017年第12期1213-1216,共4页
Chinese Circulation Journal
基金
十三五国家重点研发计划项目(2017YFC1308100)
关键词
心血管畸形
心脏外科手术
Cardiovascular abnormalities
Cardiac surgery
