十字交叉心脏的解剖特点与外科治疗选择  

The anatomical features of criss cross heart and surgical treatment

作　　者：张晗[1,2] 刘承虎[1,2] 李刚[1,2] 李建强[1,2] 程沛[1,2] 张晶[1,2] 苏俊武[1,2] 刘迎龙[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所小儿心脏中心,100029

出　　处：《心肺血管病杂志》2015年第8期622-626,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的：研究十字交叉心脏的解剖特点与外科治疗方式的选择。方法：回顾分析2002年1月至2013年12月间,在我院行手术收治的11例十字交叉心脏患儿临床资料。其中男性7例,女性3例,年龄0.25~11岁,体质量6.5~40kg。总结其解剖特点及治疗方式的选择。结果：心房正位,心室右袢,心室与连接正常2例;心房正位,心室右袢,大动脉心室连接异常7例;心房正位,心室左袢,大动脉心室连接异常2例。3例患儿伴有房室瓣畸形,1例患儿二尖瓣骑跨（B型）且二尖瓣存在大量反流,2例患儿三尖瓣骑跨;3例患儿术前超声心动提示形态右心室发育明显偏小;5例患儿伴有肺动脉瓣畸形,4例为肺动脉瓣狭窄,1例为肺动脉瓣闭锁;所有患儿均伴有室间隔缺损。手术方式包括双向Glenn术5例;肺动脉环缩术4例;室间隔缺损修补术l例;动脉导管封堵术1例,无手术死亡,均治愈出院。结论：十字交叉心脏的解剖形态复杂、病理改变多样,临床上根据患儿病情,选择不同的治疗方式。特别对于无法行双心室矫治的患儿,Fontan系列手术是一种有效的治疗方式。Objective：To study the anatomical features of criss cross heart and the surgical procedures. Methods： Review the clinical data of ten patients with eriss cross heart. They were operated on from Jan. 2002 to Dec. 2013. There were 8 males and 3 females, Their age ranged from 0. 25y to lly and their body weight ranged from 6. 5kg to 40kg. Results： The visceroatrial situs was solitus in 11 patients. The atrioventricular con- nections were concordant in 9 patients and discordant in 2. Ventriculoarterial connections were discordant in 4 patients and cordant in 6. Atrioventricular valve malformation was found in 3 patients, right ventricle was maldevelopment in 3 patients, pulmonary valve stenosis or subpulmonary valve stenosis was found in 4 and ventricular septal defect was fond in all patients. The surgical procedures were included VSD repair in 1 patient, bidirectional Glenn shunt in 5 patients, pulmonary banding in 4 patients. Both of patients were cured. Conclusion： There were a variety of morphological features in cnss cross heart. The surgical procedures should be decided depending on their morphological features. Fontan procedure is an alterative procedure for cfiss cross heart.

关 键 词：十字交叉心脏 解剖 外科治疗 

分 类 号：R54[医药卫生—心血管疾病]