左冠状动脉异常起源于肺动脉患儿86例外科治疗近期结果分析  

Surgical treatment of eighty-six child patients with anomalous left coronary artery from the pulmonary artery

作　　者：芮璐[1] 李守军[1] 张昌伟[1] 花中东[1] 王巍[1] RUI Lu;LI Shoujun;ZHANG Changwei(Pediatric Cardiac Surgery Center, NationalCenter for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, PekingUnion Medical College,Beijing 100037 ,China)

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/中国医学科学院阜外医院心血管疾病国家重点实验室小儿外科中心,100037

出　　处：《临床外科杂志》2019年第5期416-418,共3页Journal of Clinical Surgery

摘　　要：目的总结小儿左冠状动脉异常起源于肺动脉(ALCAPA)的外科治疗近期结果。方法选取2004年4月～2016年12月我院小儿心脏外科中心共治疗的ALCAPA患儿86例,全部患儿均在气管插管低温体外循环下行冠状动脉再植术,二尖瓣中度以上反流患儿同期行二尖瓣成形术,分析手术指标和围手术期术后恢复相关指标以及患儿的转归和预后,评估冠状动脉再植术和二尖瓣成形术的近期手术效果。结果住院死亡2例,平均体外循环时间和主动脉阻断时间分别为112.0分钟(95.0～141.0分钟)和73.0分钟(57.0～91.5分钟),呼吸机辅助时间和住ICU时间分别为22.0小时(8.0～93.0小时)和69.0小时(24.0～168.0小时)。3例患儿行体外膜肺氧合(ECMO)辅助并成功脱机,出院时LVEF为55.0%(34.3%～65.0%),与术前比较差异无统计学意义,出院时LVEDD为34.5 mm(27.0～38.0 mm),与术前比较明显改善,二尖瓣重度反流0例,中度反流10例。术前LVEF<50%亚组患儿,出院时LVEF显著升高[35.5%(26.0%～42.0%)vs 25.0%(19.0%～35.0%),P<0.05]。结论冠状动脉再植术治疗小儿左冠状动脉异常起源于肺动脉具有良好的近期效果。Objective To review the short-term result of surgical treatment of child patients with anomalous left coronary artery from the pulmonary artery(ALCAPA).Methods A retrospective,single institution review was conducted on 86 child patients with ALCAPA underwent coronary re-implantation.All the patients underwent coronary re-implantation procedure with cardiopulmonary bypass.Patients with moderate or severe MR underwent mitral valve repair simutanously.To evaluate the short outcome of coronary re-implantation and MVP surgery,we analyze the related factors during the surgery and perioperative recovery.Results There were two in-hospital deaths.The median cardiopulmonary bypass time and cross-clamp time were 112.0 min(95.0~141.0 min)and 73.0 min(57.0~91.5 min),respectively.The median mechanical ventilation time and intensive care unit time were 22.0 h(8.0~93.0 h) and 69.0 h(24.0~168.0 h),respectively.Three patients underwent ECMO support and weaned off successfully.The median postoperative LVEF 55.0%(34.3~65.0%)did not improved compared with the preoperative LVEF.The LVEDD 34.5 mm(27.0~38.0 mm)decreased significantly compared with preoperative LVEDD(P<0.05).in the patients with LVEF<50%,the postoperative LVEF increased significantly[(35.5%(26.0~42.0%) vs 25.0%(19.0~35.0%)],P<0.05).No patient with severe MR and ten patients with moderate MR when were discharged.Conclusion The coronary re-implantation has a satisfactory short-term result for child patients with ALCAPA.

关 键 词：左冠状动脉起源于肺动脉 冠状动脉再植 

分 类 号：R726.5[医药卫生—儿科]