完全型房室间隔缺损人工瓣膜置换一例-站在“单心室循环共瓣成形或换瓣”分岔路口的思考  

Mechanical valve replacement in complete atrioventricular septal defect-the decision making between common atrioventricular valvuloplasty and valve replacement in Fontan circulation

作　　者：杜楚豪 董硕 段亚冰 孙阳雪 闫军[1] DU Chuhao;DONG Shuo;DUAN Yabing;SUN Yangxue;YAN Jun(Department of Pediatric Cardiac Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037,P.R.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阜外医院小儿心脏外科,北京100037

出　　处：《中国胸心血管外科临床杂志》2021年第4期492-494,共3页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家重点研发计划资助(2017YFC1308100)。

摘　　要：1例12岁女性患者因“左上腔静脉-肺动脉连接术后,完全型房室间隔缺损,右室双出口,肺动脉瓣狭窄,左异构,单心房,下腔静脉-半奇静脉引流”入院。术前超声显示共同房室瓣增厚、卷曲,对合不良,中大量反流,以左侧房室瓣为主;主肺动脉发育差。手术保留房室瓣,取31#二尖瓣机械瓣,以2/0 Prolene线连续缝合于二尖瓣瓣环。横断主肺动脉,5/0 Prolene线连续缝合近端,远端与20#Gore-tex人工血管端端吻合。将肝静脉自右房壁切下,与人工血管另一端吻合。术后血氧饱和度95%~100%之间。出院前复查超声、CT示人工瓣膜功能良好、心功能正常。虽然,共同房室瓣成形是瓣膜处理的首选,但当瓣膜功能障碍过于严重、成形很可能失败的情况下,勉强进行瓣膜成形术将使手术的风险骤然提升。此时,人工瓣膜的置换为最佳选择。A 12-year-old girl with double outlet of right ventricle,complete atrioventricular septal defect,pulmonary valve stenosis,single atrium,inferior vena cava-hemiazygos vein drainage and left isomerism,who had undergone surgical left superior vena cava-pulmonary artery connection was referred to our hospital.Echocardiography revealed thickening,crimping and malalignment of common atrioventricular valve,moderate-to-severe regurgitation mainly from the left side and the main pulmonary artery was poorly developed.We preserved the autologous valve and used the 31#mechanical mitral valve which was sutured to mitral annulus.After the main pulmonary artery was transected,proximal end was sutured and a 20#Gore-tex artificial vessel was anastomosed to the distal end of the main pulmonary artery.We excised hepatic vein from the right atrium which was then anastomosed to another artificial vessel.Postoperative oxygen saturation was 95%-100%.Echocardiography and CT showed that the function of mechanical valve and heart was good before discharge.Common atrioventricular valvuloplasty is the preferred choice of the management of impaired valve.However,when dysfunction of valve is too severe and valvuloplasty is more likely to fail,the risk of barely performing a valvuloplasty will increase dramatically.On this condition,the mechanical valve replacement should be performed.

关 键 词：共同房室瓣 单心室治疗 人工瓣膜置换 

分 类 号：R726.5[医药卫生—儿科]