63例心房室管畸形的外科治疗  

Surgical treatment of atrioventricular canal defect in 63 cases

作　　者：乔衍礼[1] 褚衍林[1] 武广华[1] 马黎明[1] 王为新[1] 张洪宇[1] 李祥[1] 程前进[1] 陈国庆[1] 郑善光[1] 

机构地区：[1]济宁医学院附属医院(山东省卫生医药重点学科)心脏外科,272029

出　　处：《心肺血管病杂志》2010年第3期206-208,共3页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:总结心房室管畸形外科治疗的经验。方法:我院自2005年5月至2009年12月手术治疗心房室管畸形患者63例。其中部分性房室管畸形56例,完全性房室管畸形7例。部分性房室管畸形瓣裂修补采用间断褥式缝合并连续缝合加固;原发孔型房间隔缺损24例采用Kirklin的方法修补将冠状静脉窦开口隔入左心房,32例采用McGoon法冠状静脉窦开口保留在右心房。完全性房室管畸形7例。按Rastalli分型属A型4例,C型3例,分别采用自体心包加涤纶片的双片法(4例)或自体心包单片法(3例)修复。合并畸形均予以同期处理。结果:无早期死亡病例。术后发生低心排出量综合征(低心排)8例;Ⅲ°房室传导阻滞1例,7d后恢复窦性心律。术后随访46例,随访时间2个月～4年,心功能均为Ⅰ～Ⅱ级。结论:部分性房室管畸形手术治疗的关键,是完善修复二尖瓣关闭不全和避免房室传导阻滞。完全性房室管畸形除注重房室瓣修补完善外,强调将二尖瓣和三尖瓣环纠正至正常解剖位置,以恢复室间隔的面积和增宽左心室流出道。Objective：To summarize our experiences in surgical treatment for atrioventricular canal defect.Methods：From May 2005 to July 2009,63 patients,56 with Partial Atrioventricular Canal Defect（PACD） and 7 with Complete ACD（CACD）,accepted surgical treatment in our center.The cleft of mitral valve in PACD was repaired with interrtpted mattress sutures and then was strengthened with a continuous suture.Kirklin＇s technique was applied to repair ostium primum atrial septal defects in 24 cases,coronary sinus was situated in the left atrium.In 32 cases,MeGoon＇s technique was used;the coronary sinus was left in the right atrium.Atrioventricular septal defects were repaired in CACD using double-patches of combined Dacron and autologous pericardium patch in 4 cases,and using autologous pericardium patch only in 3 cases.Results：There was no early death.Low cardiac output syndrome happened in 8 cases and Ⅲ degree AV block happened in 1 case,which recovered to sinus rhythm 7 days after the surgery.46 cases have been followed for 2 months to 4 years.Cardiac functions were NYHA Ⅰ-Ⅱ.Conclusion：The key points of operation for PACD are to rectify the mitral insufficiency and avoid AV block.For CACD,to restore mitral and tricuspid annulus to normal anatomical position,recover the area of interventricular septum and widen out the left ventricular output tract,should be emphasized.

关 键 词：心房室管畸形 先天性心脏病 心脏外科手术 

分 类 号：R541.1[医药卫生—心血管疾病]