右冠状动脉开口位移——主动脉瓣上狭窄患儿矫治术后早期恶性心律失常的主要原因  

Right coronary ostia displacement——maybe an important factor of peri-operative mortality after SVAS correction in infant

作　　者：彭博[1] 王强[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心外科,100037

出　　处：《中华胸心血管外科杂志》2017年第10期594-597,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 探讨不同的手术方法对先天性主动脉瓣上狭窄矫治后右冠状动脉（右冠）开口的影响,避免因手术造成的右冠梗阻.方法 回顾2008年至2015年连续记录的91例主动脉瓣上狭窄病例患儿的手术方法和结果,分析早期死亡、二次开胸、ECMO辅助的原因.结果 全组术后使用呼吸机（17.87 ±46.00）h,其中69例呼吸机辅助小于12 h;ICU停留（81.24 ±197.42）h,其中41例ICU停留小于24 h.围术期死亡4例,ECMO辅助6例,二次开胸8例.术后平均随访15个月,随访主动脉压差（9.31 ±3.11）mmHg（1 mmHg=0.133 kPa）,流速（1.3 ±0.7）m/s.生存出院患儿随访期间无死亡.结论 先天性主动脉瓣上狭窄矫治不同的手术方法对右冠有影响,涉及右冠切口的操作,补片过大会梗阻右冠开口,引起恶性心律失常.术中调整右冠补片的形状及位置,对改善恶性心律失常有效.Objective Explore the influence of different surgical methods on right coronary artery opening after congeni-tal supravalvular aortic stenosis correction surgery, to avoid right coronary artery obstruction caused by surgery.Methods A retrospective analysis was made on the surgical methods and results of continuous records of 91 supravalvular aortic stenosis sur-gery cases operated from 2008 to 2015, while analyzing the cause of early death, early reoperation, and ECMO assisted.Re-sults 4 cases of perioperative death,6 cases of ECMO assisted,8 cases of reoperation,all above are concerned with early ma-lignant arrhythmia.The surviving cases were followed up for 15 months,no death cases during the followed-up.Conclusion Different surgical methods have different influences on right coronary artery, related to the operation of right coronary incision. If the patch is oversize,it will cause obstruction of right coronary artery opening and cause malignant arrhythmia,however,un-dersized patch can not relieve aortic stenosis.So different surgical methods should be used according to different age and weight of patients.

关 键 词：先天性心脏病 主动脉瓣上狭窄 

分 类 号：R726.5[医药卫生—儿科]