法洛四联症合并冠状动脉畸形的外科治疗  

Surgical Treatment of Tetralogy of Fallot with Anomalous Coronary Artery

作　　者：金晶[1] 陶凉[1] 周宏[1] 曾祥军[1] 吴向阳[1] 周丹[1] 

机构地区：[1]武汉亚洲心脏病医院胸心血管外科,武汉430022

出　　处：《中国胸心血管外科临床杂志》2013年第1期54-58,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的总结法洛四联症(TOF)合并冠状动脉畸形(ACA)手术治疗经验,探讨ACA的诊断,右心室流出道(RVOT)疏通手术方式的选择及其效果。方法回顾性分析2004年1月至2010年1月武汉亚洲心脏病医院手术矫治TOF合并ACA 29例,其中男18例,女11例;年龄7岁(5个月～33岁),体重18(5～51)kg。术前动脉血氧饱和度65%～91%。所有患者均行完全矫治手术。1例经右心房疏通RVOT,修补室间隔缺损;3例经右心房疏通RVOT,修补室间隔缺损,用自体心包片加宽主肺动脉;3例行肺动脉移位术(REV),5例患者采取"双通道"手术;11例采取冠状动脉下方、上方或者两边切口疏通,补片加宽的方法("单片"或"双片"法);6例行冠状动脉移植术后行跨瓣环补片重建RVOT。结果体外循环时间78(65～102)min,主动脉阻断时间50(40～82)min,手术时间150(126～178)min。手术未出现死亡以及严重冠状动脉损伤。术后2例因出血行二次开胸止血;2例出现低心排血量,强心药物支持后治愈。随访51(21～83)个月,随访过程中无死亡。所有患者术后心功能(NYHA)分级均为Ⅰ级,心脏射血分数均正常,心电图未提示心肌缺血,动脉血氧饱和度恢复至96%～99%。术后早期RVOT压差(△P)为19(8～38)mm Hg,术后随访患者无△P增加。结论对于TOF合并ACA患者,术前通过64排螺旋CT(64-MSCT)检查可以明确ACA诊断,术中根据冠状动脉情况选择合适的流出道疏通方法,手术效果良好。Objective To summarize our surgical experience of tetralogy of Fallot （TOF）with anomalous coronary artery （ACA）, explore diagnostic method of ACA, and evaluate surgical strategy choices and clinical outcomes of right ventricular outflow tract （RVOT） reconstruction. Methods From January 2004 to January 2010, 29 patients with TOF and ACA underwent total correction in Wuhan Asia Heart Hospital. There were l 8 male patients and 11 female patients with their median age of 7 years （5 months to 33 years）and median body weight of 18 （5 to 51 ） kg at operation. Their preoperative arterial oxygen saturation was 65%-91%. One patient underwent RVOT enlargement and repair of ventricular septal defect via right atrial approach. Three patients underwent RVOT enlargement, repair of ventricular septal defect and main pulmonary artery enlargement using autologous pericardium patch via right atrial approach, Three patients received pulmonary artery translocation （REV） technique. Five patients received double outlet technique. Eleven patients under- went RVOT enlargement via incisions above, below or beside coronary arteries （single patch or two patch technique）. Six patients underwent RVOT reconstruction using trans-annular patch after coronary artery bypass grafting. Results The median cardiopulmonary bypass time was 78 （65-102） rain, median aortic crossclamp time was 50 （40-82） min, and median operation time was 150 （126-178） min. There was no early death or severe coronary artery injury. Two patients underwent reexploration because of postoperative bleeding. Two patients had low cardiac output and were both cured with inotropic support. The median follow-up period was 51 （21-83 ）months and there was no late death during follow-up. All the patients were in New York Heart Association （NYHA） class I during follow-up, their left ventricular ejection fraction was normal, there was no sign of myocardial ischemia in electrocardiogram, and their arterial oxygen saturation was 96%-99%.Mean

关 键 词：法洛四联症 冠状动脉畸形 外科治疗 

分 类 号：R654.2[医药卫生—外科学]