改良Fontan手术加共同房室瓣置换术治疗心脾综合征  

Effects of modified Fontan procedure and common atrioventricular valve replacement on heterotaxy syndrome

作　　者：朱宏斌 刘锦纷[1] 徐志伟[1] 仇黎生 鲁亚南 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科,上海200127

出　　处：《海南医学院学报》2011年第9期1257-1259,1262,共4页Journal of Hainan Medical University

基　　金：海南医学院科研基金资助学报项目(0020110335)~~

摘　　要：目的:总结对心脾综合征患儿同时进行Fontan手术和共同房室瓣(CAVV)置换术的方法和经验。方法:对3例伴有CAVV中到重度返流的心脾综合征患儿进行Fontan手术的同时置入29～31mm的ATS机械二尖瓣,观察治疗效果。结果:无手术死亡,1例并发完全性房室传导阻滞植入心外膜永久埋藏式起搏器,随访1～6年心功能均为Ⅰ级。结论:心脾综合征患儿的CAVV存在明显的结构缺陷,CAVV成形术效果差,Fontan手术加CAVV置换术是有效可行的手术方案;在行CAVV置换术时,应尽量保留CAVV瓣下组织结构,对Fontan术后心功能的稳定尤为有利;褥式缝合时应浅缝缝针尽量置于瓣环靠近瓣叶处,避免损伤房室传导系统;术后须及早抗凝治疗,维持INR在1.5～2.5,可避免抗凝并发症的发生。Objective： To summarize the experiences of surgical treatment of Heterotaxy syndrome with modified Fontan procedure and common atrioventricular valve replacement.Methods： Three Heterotaxy syndrome patients with moderate to severe common atrioventricular valve regurgitation were treated with modified Fontan procedure combined with ATS prosthetic valve replacement.The size of valve ranged from 29 to 31mm.Results： No patient died,heart functions of the three patients were categorized as NYHA Ⅰ,one patient developed postoperative complete heart block and then treated with pacemaker inplantment.Conclusions： Modified Fontan procedure and common atrioventricular valve replacement is effective for children patients with heterotaxy syndrome,for whom CAVV angioplasty is not satisfying.During the CAVV replacement,chordal attachments should be maintained as much as possible.Besides,pledgeted interrupted sutures should be placed circumferentially around the margins of the valve.Postoperative anticoagulation therapy should start as early as possible to keep INR between 1.5-2.5.

关 键 词：FONTAN手术 共同房室瓣 心脾综合征 

分 类 号：R54[医药卫生—心血管疾病] R657.6[医药卫生—内科学]