Rastelli术后右心衰竭的临床分析  

Clinical analysis of right heart failure after rastelli procedure

作　　者：董念国[1] 孙宗全[1] 史嘉玮[1] 付平[1] 蓝鸿钧[1] 

机构地区：[1]华中科技大学同济医学院心血管病研究所华中科技大学同济医学院附属协和医院心外科,武汉430022

出　　处：《临床心血管病杂志》2002年第7期322-323,共2页Journal of Clinical Cardiology

摘　　要：目的 :回顾性分析 8例Rastelli术后右心衰竭的可能原因以及防治措施。方法 :从 1997年 8月至2 0 0 0年 8月 ,我科行Rastelli术 8例 ,全组患者均用Dacron补片修补室间隔缺损 ,同种带瓣管道重建右室肺动脉通道。结果 :术后早期死亡 1例 ,生存 7例 ,围术期右心衰竭 5例。随访 6个月～ 3年 ,除 1例顽固性心力衰竭外 ,4例生长发育良好。结论 :Rastelli术后右心衰竭发生率高 ,其原因可能与外管道置入位置和方向不恰当、室间隔缺损修补后左、右心腔大小失衡、室间隔缺损修补不严密妨碍三尖瓣隔瓣功能以及心肌缺血时间长等有关。针对这些因素 ,手术中应采取相应措施 ,术后合理的内科治疗也能较好地改善预后。Objective:To study retrospectively the possible causes, preventions and treatments of right heart failure after Rastelli procedure. Method:Between Aug., 1997 to Aug., 2000, 8 cases, including 7 males and 1 female, ranged from 6 to 12 years (mean 8.4 ± 1.2 years) underwent Rastelli procedure. There were 5 cases presenting with transposition of the great arteries, 2 with double-outlet right ventricle and 1 with pulmonary atresia. All of their correction involved closure of the ventricular septal defect with Dacron patch and use of a valved allograft conduit for the right ventricle to pulmonary artery construction. Result:There were 7 survivals and 1 early death. Five cases were complicated with right heart failure in perioperative period. In follow up from 6 months to 3 years, 4 cases had achieved excellent outcomes and 1 suffered from refractory heart failure. Conclusion:The incidence of right heart failure is high after Rastelli procedure. The occurrences maybe related to inappropriate position and orientation of the allograft outer conduit, unbalance of size of left to right heart, dysfunction of the septal leaflet of tricuspid valve resulting from untight repair of ventricular septal defect, long time of myocardial ischemia and so on. Therefore, corresponding measures should be taken during operation. Appropriate medical treatments is beneficial to clinical recovery for this complication.

关 键 词：RASTELLI术 右心衰竭 临床分析 手术后并发症 

分 类 号：R541.6[医药卫生—心血管疾病] R654.2[医药卫生—内科学]