32例改良单片法矫治婴幼儿完全性房室间隔缺损  

Modified single-patch technique for the treatment of 32 cases of complete atrioventricular septal defect in infants

作　　者：王刚[1] 周更须 王辉[1] 蒙强 Wang Gang;Zhou Gengxu;Wang Hui;Meng Qiang(Department of Cardiac Surgery,Bayi Children's Hospital,The Seventh Medical Center of PLA General Hospital,Beijing 100700,China)

机构地区：[1]解放军总医院第七医学中心儿童心脏科,北京100700

出　　处：《中国体外循环杂志》2021年第4期210-212,225,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的回顾总结改良单片法矫治婴幼儿完全性房室间隔缺损(CAVSD)的手术治疗效果和经验。方法回顾性分析2012年10月至2019年10月解放军总医院第七医学中心儿童心脏科采用改良单片法矫治CAVSD 32例患儿的临床资料。其中男13例,女19例;手术中位年龄5个月(2个月~2岁6月),体质量3.3~12.4(6.2±2.8)kg。Rastelli分型:A型29例,B型1例,C型2例。合并唐氏综合征18例,合并其它心脏畸形:动脉导管未闭8例,心内型完全性肺静脉异位引流1例,继发孔型房间隔缺损12例,永存左上腔静脉3例。全部入选患儿排除合并法洛四联症、右室双出口、单心室、大动脉转位等复杂畸形。术前共同房室瓣返流轻度21例,中度9例,重度2例。术中采用改良单片法一期矫治,同期处理合并畸形。结果全组术后早期死亡1例,死亡率3.1%,死于术后严重低心排血量综合征。术后二尖瓣中度返流3例,室间隔缺损残余分流2例,无房室传导阻滞。31例患儿术后随访3~60个月,中位随访时间28个月,随访期间无死亡病例。随访期间:3例二尖瓣中度返流继续随访,2例室间隔缺损残余分流自愈,无房室传导阻滞,无左室流出道梗阻。结论改良单片法简化了CAVSD的手术操作,采用改良单片法矫治婴幼儿CAVSD手术治疗效果满意。Objective To evaluate the clinical experience and outcome of modified single-patch technique for the treatment of complete atrioventricular septal defect(CAVSD)in infants.Methods From October 2012 to October 2019,the clinical data of 32 patients(13 males and 19 females,age 5 months(2 months-2.5years),body weight(6.2±2.8)kg(3.3-12.4 kg))underwent total correction for CAVSD with modified single-patch technique were collected and analyzed.The anatomic subtype included 29 cases of Rastelli A,1 case of Rastelli B,2 cases of Rastelli C.There were 18 cases with Down syndrome and other cardiac malformation,including patent ductus arteriosus in 8 cases,total anomalous pulmonary venous drainage(intracardiac type)in 1 case,secondary atrial septal defect in 12 cases,and persistent left superior vena cava in 3 cases.Patients complicated with complex malformation such as tetralogy of Fallot,double outlet of right ventricular,single ventricle and transposition of great arteries were excluded.The common atrioventricular valve regurgitation was mild in 21 cases,moderate in 9 cases and severe in 2 cases.Results There was 1 patient(3.1%)died of low cardiac output syndrome early postoperatively.There were 3 cases of moderate mitral regurgitation,2 cases of residual ventricular septal defect and no atrioventricular block.31 patients were followed up for 3-60 months(median,28 months)and no death occurred during the follow-up.Conclusion The modified single-patch technique simplified the surgical protocol of CAVSD and achieved satisfactory surgical treatment effect.

关 键 词：完全性房室间隔缺损 先天性心脏病 改良单片法 婴幼儿 心肺转流 

分 类 号：R726.5[医药卫生—儿科]