房(室)间隔缺损合并二尖瓣关闭不全的外科治疗  

Surgical Treatment of Ventricular or Artrial Septal Defect with Mitral Incompetence

作　　者：高廷朝[1] 徐洪耀[1] 王平凡[1] 朱汝军[1] 李有金[1] 刘淼[1] 

机构地区：[1]河南省胸科医院心血管外科,郑州市450003

出　　处：《医药论坛杂志》2008年第16期13-14,共2页Journal of Medical Forum

摘　　要：目的先天性心脏病房（室）间隔缺损合并二尖瓣关闭不全是临床手术中经常遇到的问题，如不处理二尖瓣关闭不全可引起术后低心排、多器官功能衰竭，增加围术期的风险性。方法我们于2006年9月-2008年1月共完成房（室）间隔缺损手术1174例，其中二尖瓣关闭不全成形者98例，男性46例，女性42例，年龄3月-17岁，平均体重（21±3．5）kg，术前心胸比0．6±0．03，彩超二尖瓣反流面积（3．5±0．6）cm^2，肺动脉高压（75±21）mmHg。术前前列地尔降肺动脉压治疗2周，纠正支气管炎及全身营养不良，在全麻浅至中低温体外循环下进行心内直视术，经房间隔切口显露二尖瓣，对不同情况分别采用节段性环缩法、叶间裂间断缝合、腱索缩短术、缘对缘缝合法及Carpintier环成形法，左室注水试验检查效果，术终测左房压（18±4．5）cmH2O。结果全组无手术死亡例，1例术后低心排、肾衰，经抢救治疗后痊愈。2周后彩超检查无反流者89例，微量一少量反流者8例，中度反流者1例，术后二尖瓣舒张期血流速度降低，跨瓣压差减小，心胸比降低。结论房室间隔缺损合并二尖瓣关闭不全术中要同时行成形治疗，采用联合成形法效果满意。Objective To study the efficacy and clinical experience of surgical treatment in the patients with ventricular or at＇trial septal defect （ VSD or ASD） with mitral incompetence （ MI ）. Methods Ninety- eight patiens with VSD or ASD with MI underwent operation between September 2006 and January 2008. The age was from three months to seventeen years. The everage body weight was （21 ± 3.5 ）kg. The average cardiothoracic ratio was 0. 6 ± 0. 03. The average regurgtant erea in left artrium was （3.5 ± 0. 6 ）cm^2. The average pulmonary pressure was （75 ±21 ）mm Hg. Before operation, the prostacyclin was used to reduce pulmonary pressure for two weeks. The bronehopulmonia and malnutrition were corrected before operation . Under general anesthesia and hypothermia cardiopulmonary bypass. Mitral was exposed by septum incision . Mitral valvuloplastys were carried out by varied methods ,including segmental annular remodeling,interrupted suturing the valve fissure, choral shortening, edge to edge valve repair, etc. depended on the anatomical variation of the lesions. The repaired effects were tested by pouring water into left ventrical . The average left artrial pressure was （ 18 ± 4. 5 ）emil20 at the end of operation. Results There were no post - operative death in the group . One had the low cardiac output syndrome and renal failure. He was cured after treatment. On 2nd week after operation 89 patients showed no regurgitation with color ultrasonography,8 patients showed slight regurgitation, 1 patient showed moderate regurgitation. In post - operative time, the mitral blood velocity at diastolic time reduced,transmitral pressure differece lowered. C - T rate brought down. Conclusion Moderative or high mitral regurgitation must be treated at the same time in the operation of VSD or ASD. Comperative mitral plasty should be used.

关 键 词：房间隔缺损 室间隔缺损 二尖瓣关闭不全 

分 类 号：R654.2[医药卫生—外科学]