小儿肺动脉瓣下室间隔缺损型法洛四联症的外科治疗  

Surgical treatment of tetralogy of Fallot with subpulmonary ventricular septal defect in young children

作　　者：朱雄凯[1] 俞建根[1] 胡劲[1] 薛品荣[1] 张泽伟[1] 李建华[1] 

机构地区：[1]浙江大学医学院附属儿童医院,杭州310003

出　　处：《浙江医学》2002年第2期79-80,共2页Zhejiang Medical Journal

摘　　要：目的探讨小儿肺动脉瓣下室间隔缺损型法洛四联症的解剖特征和手术方法。方法对37例小儿肺动脉瓣下室间隔缺损型法洛四联症采用体外循环心内直视法洛四联症根治术,并与普通四联症作比较。结果该四联症无圆锥隔,肺动脉瓣环和主动脉瓣环直接相连接,右室流出道梗阻以右室游离壁肥厚为主,需用补片加宽右室流出道以解除其梗阻者占97.3%,而普通四联症需补片加宽解除右室流出道梗阻者占76.01%(P<0.01);术后发生低心排综合征5例,3d即控制,住院死亡1例(2.70%)。结论该四联症室间隔缺损修补须防止左室流出道狭窄,宜补片加宽右室流出道以解除其梗阻,而不宜过多切除肥厚肌束。Objective To study the anatomic characteristics and surgical treatment of tetralogy of Fallot(TOF) with subpulmonary ventricular septal defect in young children.Methods Thirty sever patients of TOF with subpulmonary ventricular septal defect were retrospectively analysed and compared with ordinary TOF.There were 24 males and 13 females with a mean age of (4.8±2.2) years.All patients underwent intracardiac correction of TOF under extracorpareal circnlation and the correct rcpair was achived by operation.Results TOF with subpulmonary ventricular septal defect is absent of infundibular septum and pulmonary valve annulus directly connect with aortic valve annulus.Right ventricular outflow tract obstructioin is obvious in hypertrophic right ventricular dissociative wall.It was involved in 97.73% patients who needed patch in the reconstruction of the right ventricular outflow tract.However,in ordinary TOF,there was 76.01% patients needed patch(P<0.01).Five cases had low cardiac output syndrome postoperatively it was controlled in 3 days.There was 1 death in hospital.Conclusions For this type of TOF it is necessary prevent left ventricular outflow tract obstruction during closure of the ventricular septal defect.It should use a patch to widen the right ventricular outflow tract,but not over resect the hypertrophic muscular band.

关 键 词：先天性心脏病 法洛四联症 肺动脉瓣下室间隔缺损 儿童 

分 类 号：R726.5[医药卫生—儿科]