杂交技术在肺动脉闭锁合并室间隔完整患者中的应用  

Application of hybridization technique in patients suffering congenial pulmonary atresia with intact ventricular septum

作　　者：杨斌[1] 徐敬[1] 周志明[2] 王轲[2] 陈健超[2] 陈红领[2] 温萌[2] 梁巧茹[3] 

机构地区：[1]郑州大学第一附属医院心血管外科,450000 [2]郑州市第七人民医院心血管外科 [3]河南省胸科医院体外循环科

出　　处：《心血管外科杂志（电子版）》2015年第4期8-11,共4页Journal of Cardiovascular Surgery(Electronic Edition)

摘　　要：目的总结应用杂交技术治疗肺动脉闭锁合并室间隔完整（PA-IVS）患者的治疗效果。方法 2012年1月至2014年12月我科连续收治5例PA-IVS患者,男3例,女2例,年龄1.2-4.5个月,血氧饱和度（SaO2）（58.2±5.3）%,彩色超声显示均为肺动脉膜状闭锁,动脉导管未闭,三尖瓣大量反流,房间隔卵圆孔（PFO）未闭,右向左分流,未见冠状动脉右心室漏,右心室三部分结构均存在,三尖瓣及右心室发育不良,右心室壁肥厚,肺动脉发育良好,手术均分期进行,一期手术均在超声引导下经右心室壁穿刺肺动脉瓣,分次球囊扩张肺动脉瓣,二期手术均在体外循环下行心内畸形矫治。结果所有患者均存活,一期手术后SaO2上升至（92.6±1.5）%,未处理动脉导管,也未加做体肺分流,彩色超声显示跨肺动脉瓣血流速度（2.7±0.8）m/s,三尖瓣少量反流4例,中量反流1例,均顺利康复出院,住院时间（10±1.3）d,随访无二次手术前死亡患者,均无明显缺氧表现,运动耐量好转。二期手术无死亡患者,均顺利康复出院,住院时间（13±2.6）d,其中双心室矫治3例,11/2心室矫治2例,术后SaO2（98±0.2）%,随访6-30个月,患者NYHA心功能均为Ⅰ-Ⅱ级,SaO2（98±0.1）%,三尖瓣未见反流4例,少量反流1例,肺动脉瓣前向血流速度（1.8±0.4）m/s,两例11/2心室矫治患者上腔静脉与肺动脉吻合口血液流速约0.7 m/s。结论应用杂交技术治疗PA-IVS患者临床效果满意,安全性高,近中期随访预后良好。Objective To summarize the therapeutic effects of application of hybridization technique in patients suffering congenial pulmonary atresia with intact ventricular septum（ PA-IVS）. Methods From January2012 to December 2014,we treated 5 patients with PA-IVS,3 male and 2 female,age range from 1. 2 months old to4. 5 months old,oxyhemoglobin saturation（ SaO2） was（ 58. 2 ± 5. 3） %. Doppler ultrasound showed pulmonary membrane atresia,patent ductus arteriosus（ PDA）,severe tricuspid regurgitation,patent foramen ovale（ PFO） and left-to-right shunt. There was no RV-CA fistula,three parts structure of right wentricle all existed,tricuspid valve and right ventricle were dysplasia,right ventricular was hypertrophy,pulmonary artery was well-developed in all patients. Operations were performed in stages. In the first phase of the surgery,we punctured pulmonary valve through right ventricular outflow tract guiding by ultrasound and did the catheter pulmonary valvotomy more than once. In the second stage,we completely repaired heart abnormalities under extracorporeal circulation. Results Five patients all recovered and discharged from hospital with SaO2（ 92. 6 ± 1. 5） %,without PDA or B-T shunt,PVVmax was（ 2. 7 ± 0. 8） m / s,4 patients with mild tricuspid regurgitation（ TR） and 1 patient with moderate TR. All patients stayed in hospital for（ 10 ± 1. 3） days. No patient died before two stage operations. All patients had no obvious appearance of anoxia and exercise capacity were improved. No patient died in the second stage operation. All patients stayed in hospital for（ 13 ± 2. 6） days. 3 patients achieved 2-ventricle circulation. The other 2 patients achieved 11/2-ventricle circulation. After the second stage procedure all patients＇ SaO2was（ 98 ± 0. 2） %. During the6-30 months＇ follow-up,all patients showed NYHA ClassⅠorⅡ,SaO2was（ 98 ± 0. 1） %; 1 of them had mild TR,4of them had no TR. The PVVmax was（ 1. 8 ± 0. 4） m / s. Blood flow velocity of the superior vena c

关 键 词：肺动脉瓣闭锁合并室间隔完整 杂交技术 球囊扩张 11/2心室矫治 

分 类 号：R654.2[医药卫生—外科学]