肺动脉瓣下室间隔缺损241例临床分析  

Clinical analysis for 241 cases of subpulmonic ventricular septal defect

作　　者：韩劲松[1] 王辉山[1] 李新民[1] 汪曾炜[1] 朱洪玉[1] 尹宗涛[1] 韩宏光[1] 

机构地区：[1]沈阳军区总医院心血管外科,110016

出　　处：《中国医师进修杂志》2010年第29期19-21,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的总结肺动脉瓣下室间隔缺损（SPVSD）的临床特点及治疗经验。方法回顾性分析241例SPVSD患者的临床资料。结果术前经超声心动图确诊215例，误诊26例（10．79％，26／241）。合并主动脉瓣脱垂42例，心电图多表现为左室肥大。均行室间隔缺损（VSD）心内修复术，同期行主动脉瓣置换术（AVR）8例，主动脉瓣成形术（AVP）6例，合并其他病变亦同期处理。术中证实VSD大小比术前彩超测量值偏大。无围手术期死亡，无一例出现第三度房室传导阻滞。230例术后随访3个月至5年，随访率95．44％（230／241），NYHA心功能Ⅱ级189例，Ⅱ级41例。均无VSD残余漏。行AVR或AVP患者，术后轻度关闭不全1例，余关闭良好，其他合并病变处理随访结果亦满意。结论加强对SPVSD的全面认识，提高诊断的准确率，积极手术治疗，合理处理主动脉瓣病变及其他合并畸形或病变，可取得满意的疗效。Objective To summarize the clinical features and treatment experience of subpulmonic ventricular septal defect （SPVSD）. Method The clinical data of 241 cases of SPVSD were analyzed retrospectively. Results Two hundred and fifteen cases were confirmed by echocardiography before operation, while other 26 cases were misdiagnosed （ 10.79%, 26/241 ）, 42 cases with aortic valve prolapsed, ECG showed left ventricular hypertrophy. All patients underwent surgical repair of VSD. Other procedures had been done in the same stage including aortic valve replacement （AVR） in 8 cases, aortic valvuloplasty （AVP） in 6 cases and other operations. The size of VSD was larger than the value echocardiography measured before operation. There were no perioperative death and no complete atrioventricular block. Two hundred and thirty cases （95.44%, 230/241 ） were followed up for 3 months to 5 years. The cardiac function （NYHA） in 189 cases were grade Ⅰ and 41 cases were grade Ⅱ. There was no residual shunt of VSD. Among patients who underwent AVP or AVR, 1 case developed mild insufficiency, others developed well. Others underwent another operations all developed well. Conclusion To achieve satisfactory results, it should enhance . the overall understanding of SPVSD, improve the diagnostic accuracy of SPVSD, take positive surgical repair of VSD and reasonable treatment with aortic valve disease, and other malformation or disease.

关 键 词：室间隔缺损 肺动脉瓣 外科手术 

分 类 号：R65[医药卫生—外科学]