特殊的房室间隔缺损一例  

Atrioventricular septal defect: A case report

作　　者：石卓[1] 俞劲[2] 齐建川[1] 陈自力[1] 李建华[1] SHI Zhuo;YU Jing;QI Jianchuan;CHEN Zili;LI Jianhua(Heart Center,Affiliated Children's Hospital,Zhejiang University School of Medicine,Hangzhou,310003,P.R.China;Department of Ultrasonography,Affiliated Children's Hospital,Zhejiang University School of Medicine,Hangzhou,310003,P.R.China)

机构地区：[1]浙江大学医学院附属儿童医院心脏外科,杭州310003 [2]浙江大学医学院附属儿童医院超声科,杭州310003

出　　处：《中国胸心血管外科临床杂志》2021年第6期750-752,共3页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：浙江省科技厅国际科技合作项(2016C54006);浙江省卫生高层次人才培养工程(2016-6)。

摘　　要：患儿,男,1岁,发现心脏杂音1年入院。1年前出生后常规体检发现心脏杂音,行心脏超声检查提示"完全性房室间隔缺损,继发孔房间隔缺损,动脉导管未闭,左上腔残存,肺动脉高压",分别于3个月龄、6个月龄、9个月龄、1周岁门诊随访复查。无喂养困难,生长发育无明显落后,发育曲线位于40%百分位,无反复呼吸道感染史。心脏超声提示室间隔缺损逐渐形成膜部瘤,9个月龄时自愈,无心室水平分流。1周岁以"部分性房室间隔缺损"入院并接受手术治疗。术中探查可见动脉导管2 mm,原发孔房间隔缺损12 mm,房室瓣分隔为两组,左侧房室瓣呈三叶:前瓣、后瓣及侧瓣,前后瓣间裂缺自游离缘裂至根部。瓣环无扩大,可通过13 mm探子。右侧房室瓣发育良好,隔瓣下可及纤维增生及粘连,未见室间隔缺损。予以结扎动脉导管,间断缝合左侧房室瓣裂缺,自体心包补片(戊二醛固定)修剪后修补原发孔房间隔缺损,冠状静脉窦隔于右房侧。术后复查心脏超声示左右侧房室瓣均为轻微反流。完全性房室间隔缺损的室间隔缺损自愈甚为罕见,提示临床上对于无明显临床症状、生长发育正常、无继发瓣膜损害的完全性房室间隔缺损患者可采取随访、择期手术的策略。The patient,male,1 year,was admitted to our hospital with cardiac murmur.Cardiac ultrasonography showed"complete atrioventricular septal defect(C-AVSD),secondary orifice atrial septal defect(ASD),patent ductus arteriosus(PDA),left superior vena cava,and pulmonary hypertension".The patient got follow-up at the age of 3,6,9 months and 1 year,with no feeding difficulties,no obvious underdevelopment and no history of repeated respiratory infections.Cardiac ultrasonography showed that the ventricular septal defect(VSD)healed spontaneously at 9 months of age.At 1 year of age,he was admitted to the hospital with"partial atrioventricular septal defect(P-AVSD)"and accepted surgery.Intraoperative exploration showed that the primary orifice ASD was 12 mm,the atrioventricular valve was divided into two groups,and the left atrioventricular valve had three leaflets:anterior,posterior,and lateral one.A cleft was between the anterior and posterior leaflets.The annulus was not enlarged with diameter of 13 mm.The right atrioventricular valve developed well,with fibrous hyperplasia and adhesion under the septal valve.No VSD was seen.The cleft was sutured intermittently.Autologous pericardial patch was used to repair the primary orifice ASD,and the coronary sinus was separated into the right atrium.Self-healing of VSD patients with C-AVSD is very rare,suggesting that patients with C-AVSD with normal range of development,and without obvious clinical symptoms and secondary damage,should be followed up and accept elective surgery in clinical practice.

关 键 词：房室间隔缺损 自愈 外科治疗 病例报告 

分 类 号：R726.5[医药卫生—儿科]