动脉导管未闭合并功能性二尖瓣返流的治疗策略  

Treatment strategy for patent ductus arteriosus associated with functional mitral regurgitation

作　　者：黄健兵[1] 丁芳宝[1] 张韫佼[1] 张丽[1] 徐高俊 梅举[1] 

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海市200092

出　　处：《中国心血管病研究》2016年第12期1119-1122,共4页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金（项目编号：81570290）;上海市科委科技项目（项目编号：15411952600）

摘　　要：目的 探讨动脉导管未闭（PDA）合并功能性二尖瓣返流的治疗策略及疗效.方法 回顾性分析2008年1月至2015年7月在本院实施手术治疗的65例PDA合并功能性二尖瓣返流患者的临床资料,其中有轻度二尖瓣返流16例、中度返流26例、重度返流23例;41例行介入封堵术,19例行左侧经胸切口动脉导管结扎术,3例成人患者合并重度二尖瓣返流者行体外循环下PDA结扎及二尖瓣成形术,2例左室明显扩大伴重度二尖瓣返流、心功能低下者先行PDA封堵,2周后再行体外循环下二尖瓣成形术.术后3个月随访复查心脏彩超了解二尖瓣返流情况.结果 围术期无死亡.PDA术后均无残余分流.8例术前有反复肺部感染的患儿术后呼吸机辅助2～5 d后顺利脱机,其余患者均恢复顺利.单纯处理PDA的患者（共60例）,术后3个月心彩超提示：二尖瓣无返流26例,轻度返流24例,中度返流10例,无重度返流病例.5例行体外循环手术患者术后均恢复良好,3例一期手术者术后二尖瓣返流为轻度以下,2例分期行成形者术后二尖瓣返流为轻度、轻偏中度.结论 对PDA合并功能性二尖瓣返流患者,单纯处理动脉导管即可获得良好的效果.对合并极重度二尖瓣返流伴左室扩大、心功能不全患者,行分期手术可获得良好的手术效果.Objective To investigate the treatment strategy of patent ductus arteriosus associated with functional mitral regurgitation, and its therapeutic effect. Methods A retrospective analysis of 65 cases of PDA combined with functional mirtal regurgitation treated in our hospital. Including mild mitral regurgitation in 16 cas- es, 26 eases of moderate regurgitation, 23 cases of severe regurgitation. 41 cases underwent transcatheter closure, 19 cases got ductus arteriosus ligation by transthoracic incision. 3 cases of adult patients with severe mitral regurgi- tation got PDA ligation and mitral valvuloplasty with cardiopulmonary bypass. Two cases with severe left ventricular enlargement, significant mitral regurgitation, and cardiac dysfunction, got transcatheter closure of PDA, and got mitral valvuloplasty two weeks later. After 3 months follow-up, review the mitral regurgitation situation by echocar- diography. Results No perioperative deaths happened. All patients have no postoperative residual shunt. 8 pedi- atric patients with preoperative pulmonary infection got 2 to 5 days of postoperative ventilation. The other patients all recovered smoothly. 60 patients simple processing PDA, review echocardiography 3 months after surgery, no mitral regurgitation in 26 cases, mild regurgitation in 24 cases, moderate regurgitation in 10 cases, and no cases of severe regurgitation. 3 patients with one-stage operation have mild or less mitral regurgitation. 2 patients with staged surgery have mild and mild to moderate mitral regurgitation. Conclusion To the patients of PDA combined with functional mitral regurgitation, simple treat the PDA often can get good results. To the PDA patients combined with extremely severe mitral regurgitation, severe enlargement of left ventricular, heart failure, staged surgery can be safe.

关 键 词：动脉导管未闭 功能性二尖瓣返流 外科治疗 

分 类 号：R654.2[医药卫生—外科学]