22例先天性心脏病术后主动脉瓣下狭窄的再次手术  

Reoperation of 22 cases with subaortic stenosis after congenital heart disease

作　　者：王栋[1] 吴永涛[1] 王执一 刘迎龙[1] 程沛[1] 苏俊武[1] 范祥明[1] WANG Dong;WU Yongtao;WANG Zhiyi;LIU Yinglong;CHENG Pei;SU Junwu;FAN Xiangming(Department of Pediatric Cardiac Surgery,Beijing Anzhen,Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所小儿心脏中心,100029

出　　处：《心肺血管病杂志》2020年第5期510-513,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:总结先天性心脏病术后主动脉瓣下狭窄的手术经验及手术疗效。方法:回顾性分析2011年2月至2017年12月,行先心病术后主动脉瓣下狭窄外科矫治的22例患儿临床资料,其中男性13例,女性9例。原发心脏畸形包括室间隔缺损、心内膜垫缺损、主动脉弓缩窄、右心室双出口、法洛四联症、动脉导管未闭等。初次手术矫治年龄2个月~4岁(中位年龄0.85岁),术后主动脉瓣下狭窄矫治年龄1.6~15.9岁,平均(7.49±4.09)岁,与初次手术间隔1~15.3年,平均(6.22±3.63)年。结果:所有患儿均行主动脉瓣下狭窄矫治术,无术中死亡;跨左心室流出道压差从术前52~169 mm Hg (1 mmHg=0.133 kPa),平均(94.09±25.02)mm Hg降至术后5~47 mm Hg,平均(16.19±10.87)mm Hg(P<0.05)。1例术后Ⅲ°房室传导阻滞并安装永久性心脏起搏器。所有患儿均常规随访1~8年,术后均无症状,心功能正常,无远期死亡。结论:先天性心脏病术后的主动脉瓣下狭窄考虑左心室流出道血流动力学紊乱造成,其原发畸形复杂多变,再次手术时间间隔较长,且术后仍有复发可能。Objective:To summarize surgical experience and outcomes of postoperative-subaortic stenosis(po-SAS)after congenital heart disease surgery.Methods:The clinical data of 22 children undergoing po-SAS surgical treatment from February 2011 to December 2017 were retrospectively analyzed,including 13 males and 9 females.The primary cardiac malformations include ventricular septal defect,endocardial cushion defect,coarctation of aorta,right ventricle double outlet,tetralogy of Follat and patent ductus arteriosus.The age of primary surgery ranged from 2 month to 4 years(median age 0.85 years),and the age of po-SAS was(7.49±4.09)years(1.6-15.9 years),which was(6.22±3.63)years(1-15.3 years)from the initial surgery.Results:All patients underwent po-SAS repair and no intraoperative death occurred in this study.The gradient pressure across the left ventricular outflow tract was reduced from(94.09±25.02)mm Hg(52-169)mmHg to(16.19±10.87)mm Hg(5-47 mm Hg)after surgery(P<0.05).One patient developed complete atrioventricular block and a permanent cardiac pacemaker was installed.All patients were followed up for 1 years to 8 years.All patients were asymptomatic,with normal heart function and no long-term death.Conclusions:The subaortic stenosis after congenital heart disease operations is considered to be caused by hemodynamic disorder of left ventricular outflow tract.The primary malformation of po-SAS are complex and variable.The timing of re-operation may be relatively prolonged,and there is still a possibility of recurrence after surgery.

关 键 词：先天性心脏病 主动脉瓣下狭窄 再次手术 

分 类 号：R54[医药卫生—心血管疾病]