Barbero-Marcial术式在复杂型先天性心脏病中的应用  

Experience of Barbero-Marcial operation in patients with complex congenital heart disease

作　　者：黄景思[1] 孙善权[1] 李虹[1] 杨伟健[1] 邹鹏[1] 孔娟娟[1] 饶姣 刘琴[1] HUANG Jing-si;SUN Shan-quan;LI Hong;YANG Wei-jian;ZOU Peng;KONG Juan-juan;RAO Jiao;LIU Qin(Department of Cardiac Center,Guangdong Children′s Hospital,Guangdong Women and Children Hospital,Guangzhou 511442,China)

机构地区：[1]广东省妇幼保健院广东省儿童医院心脏中心,广州511442

出　　处：《岭南心血管病杂志》2017年第6期715-717,共3页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨Barbero-Marcial术式在复杂型先天性心脏病(congenital heart disease,CHD)无法行右心室流出道(right ventricular outflow tract,RVOT)重建患者中的应用。方法 2007年10月至2016年10月广东省儿童医院心脏中心12例[男9例,女3例,年龄21.3个月(17 d^13岁),体质量11.8(3~33)kg)]复杂型CHD应用Barbero-Marcial术式行RVOT重建。全组均采用左或右心耳覆盖左或右冠状动脉替代肺动脉主干底部,自体心包缝制瓣兜的牛心包片覆盖于上方,重建右心室-肺动脉连接。结果早期死亡2例(17%)。均死于顽固性低心排血量综合征。中位时间分别为:体外循环205.3(119~403)min,主动脉阻断93.8(49~148)min,辅助循环78(32~125)min,机械通气82.5(12~168)h。术后主要并发症包括乳糜胸2例,中毒性脑病1例。10例出院后随访1个月~9年,超声提示无RVOT狭窄,肺动脉轻度反流。所有患儿纽约心脏协会心功能Ⅰ或Ⅱ级。结论 Barbero-Marcial术式安全、有效,且具有生长潜能,可免除因肺动脉狭窄而再次手术,推荐应用于无法常规行RVOT重建的复杂型CHD患者。Objectives To explore the application of Barbero-Marcial operation in patients with complex congenital heart disease(CHD)that can′t receive reconstruction of right ventricular outflow tract(RVOT).Methods Totally12patients with complex CHD from October2007to October2016in Guangdong Children′s Hospital were performed with Barbero-Marcial operation for reconstruction of RVOT.There were9male and3female patients with the median age of21.3months(17day to13year)and body weight of11.8(3-33)kg.Left or right atrium ears were used to cover left or right coronary artery instead of the bottom of pulmonary artery trunk in all the patients,and autologous pericardial pocket of bovine pericardium covered above to reconstruct right ventricular pulmonary artery connection.Results Two cases died of serious low cardiac output syndrome after operatuion.Median duration of cardiopulmonary bypass was205.3(119-403)minutes,median duration of aortic cross clamp was93.8(49-148)minutes,median duration of aux?iliary circulation was78(32-125)minutes and median duration of mechanical ventilation was82.5(12-168)h.Postop?erative complication included two chylothorax and1encephalopathia toxica.The mean follow-up duration for10survi?vors was1months to9years.There was no stenosis at RVOT and mild reflux at pulmonary artery indicated by echocar?diography.All the patients were with New York Heart Association(NYHA)gradeⅠorⅡ.Conclusions Barbero-Marcial surgery is a safe and effective operation method.It has growth potential and can avoid reoperation due to pulmo?nary artery stenosis.It is recommended for patients with complex CHD who can′t receive reconstruction of RVOT.

关 键 词：心脏缺损 先天性 Barbero-Marcial 右心室流出道重建 

分 类 号：R541.1[医药卫生—心血管疾病]