先天性主动脉瓣下狭窄103例的外科治疗  

Surgical treatment for 103 patients with congenital subvalvular aortic stenosis

作　　者：朱平[1] 张镜芳[1] 庄建[1] 吴若彬[1] 肖学钧[1] 郑少忆[1] 卢聪[1] 陈欣欣[1] 陈寄梅[1] 刘菁[1] 

机构地区：[1]广东省人民医院广东省心血管病研究所心外科,广州510080

出　　处：《岭南心血管病杂志》2007年第3期203-205,共3页South China Journal of Cardiovascular Diseases

摘　　要：目的总结分析先天性主动脉瓣下狭窄103例手术治疗的临床经验。方法1988年1月～2006年6月,手术治疗先天性主动脉瓣下狭窄103例,其中,隔膜型狭窄97例,管型狭窄6例。在体外循环下,行单纯狭窄隔膜或肌纤维环切除术92例,左心室流出道肌肉部分切削或切开21例,29例合并主动脉瓣病变者行主动脉瓣替换术,同期矫治其它合并畸形。结果①本组早期死亡2例,病死率1.94%,其中1例因术后严重心律失常,心搏骤停,抢救无效死亡,另1例因术后严重低心输出量综合征死亡。其余101例患者,经治疗,痊愈出院,其中84例患者术后心脏杂音消失;②术前、术后早期压差比较,术后早期跨左心室流出道压力阶差(left ventricular outflow tract gradient,LVOTG)为0～16(4.9±3.4)mmHg;与术前LVOTG比较,差异有统计学意义(P<0.001)。结论先天性主动脉瓣下狭窄—经诊断宜尽早手术治疗,根据其病理解剖特点选择不同的手术方法,如切除隔膜或纤维环,必要时加部分肌肉切开(或)切除术,以便彻底解除狭窄,避免并发症。Objectives To summarize the clinical experience of operative treatment for 103 patients with congenital subvalvular aortic stenosis. Methods From January 1988 to June 2006, we had performed operative treatment for 103 patients with congenital subvalvular aortic stenosis. Among them, there were 97 cases of diaphragmatic stenosis and 6 cases of spinal stenosis. Under extracorporeal circulation, resection of pure diaphragmatic stenosis or cardiac muscular annuli fibrosis was performed for 92 patients; which was added with muscular cutting or incision in left ventricular outflow tract （LVOT） for 21 patients. 29 patients combined and aortic valvular disease were provided with aortic valve replacement. Corrective therapies for other endocardial abnormality were performed during the same period. Results （1） In early phase of this group, there were 2 cases of death （death rate： 1.94%）. Among them, one patients died from severe arrhythmia and cardiac arrest after operation ; one patient died from severe low cardiac output, The rest were cured. Among them, 84 patients had their cardiac murmur removed and the rest patients had their cardiac murmur weakened remarkably after operation. （2）LVOT gradient（LVOTG） before operation and in early phase after operation was 0-16 （4.9±3.4） mm Hg （P〈0.001） compared to the LVOTG before operation. Conclusions It is advisable to perform operative therapy for congenital subvalvular aortic stenosis as soon as possible. Operative method should be determined according to the pathology and dissection features, such as resecting the diaphragm or annuli fibrosis. If necessary, muscular incision or resection can be added, so as to eliminate the stenosis thoroughly and to prevent from complication.

关 键 词：先天性心脏病 主动脉瓣下狭窄 手术治疗 

分 类 号：R541.1[医药卫生—心血管疾病]