右心室Overhaul技术在复杂先心病合并右心室发育不良手术中的运用  

Application of right ventricular Overhaul technique in the operation of complex congenital heart disease complicated with right ventricular dysplasia

作　　者：黄健兵[1] 梅举[1] 姜兆磊[1] 张韫佼[1] 张丽[1] 丁芳宝[1] HUANG Jian-bing;MEI Ju;JIANG Zhao-lei;ZHANG Yun-jiao;ZHANG Li;DING Fang-bao(Department of Cardiothoracic Surgery,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medical,200092 Shanghai,China)

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海市200092

出　　处：《中国心血管病研究》2022年第2期138-142,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的总结右心室Overhaul技术在治疗伴右心室发育不良的复杂先天性心脏病中的运用经验,探讨术中操作要点,评估其近中期疗效。方法回顾性分析我科2006年1月至2021年4月间采用右心室Overhaul技术治疗的合并有右心室发育不良的22例先天性心脏病患者的临床资料,男14例,女8例,其中室间隔完整的肺动脉闭锁15例,房室间隔缺损伴动脉导管未闭2例,三尖瓣下移畸形伴房间隔缺损3例,三尖瓣发育不良伴动脉导管未闭及房间隔缺损2例。所有患者术前均经超声心动图明确具有右心室发育不良。术中使用右心室Overhaul技术扩大右心室腔,并同期处理部分合并的心脏畸形。结果全组患者均顺利完成右心室Overhaul手术及部分合并畸形的矫治,围术期无死亡病例。术后呼吸极辅助通气时间(16.9±13.5)h,术后住院时间(7.2±2.8)d;术后/术前右心室容积比为(2.3±0.9)倍。随访3个月~15年,2例患者分别随访2年及4年后因右心室腔小、明显发绀,再次行右心室Overhaul手术,14例患者随访右心室发育情况良好,再行根治手术。6例患者仍在随访中。所有患者首次手术后末梢氧饱和度及活动耐力较术前明显提高,患者心功能Ⅰ~Ⅱ级,活动耐量良好。结论右心室Overhaul技术可安全用于部分具有双心室结构,但右心室发育不良无法一期行根治手术的复杂先天性心脏病患者,可有效提高末梢氧饱和度、改善患者活动能力,并为可能的双心室根治手术创造条件。Objective To summarize the application experience of right ventricular Overhaul technology in the treatment of complex congenital heart disease with right ventricular dysplasia and explore the key points of intraoperative operation and evaluate the short-term and medium-term efficacy of this treatment method. Methods The clinical data of 22 patients with congenital heart disease complicated with right ventricular dysplasia from January 2006 to April 2021 were retrospectively analyzed. They were all treated by right ventricular overhaul technique. There were 14 males and 8 females. There were 15 cases of pulmonary atresia with intact ventricular septum, 2 cases of atrioventricular septal defect with patent ductus arteriosus, 3 cases of tricuspid valve depression with atrial septal defect, and 2 cases of tricuspid valve dysplasia with patent ductus arteriosus and atrial septal defect. All the patients had right ventricular dysplasia confirmed by cardiac color Doppler ultrasound before operation. During the operation, the right ventricular Overhaul technique was used to expand the right ventricular cavity and some combined cardiac malformations were used at the same time. Results All the patients successfully underwent the right ventricular overhaul operation and the correction of some combined malformations. There was no death during the perioperative period. The postoperative intubation time was(16.9±13.5) hours, and the postoperative hospital stay was(7.2 ± 2.8) days. The postoperative/preoperative right ventricular volume ratio was(2.3±0.9)times. The patients were followed up for 3 months to 15 years. Two patients were performed the right ventricular Overhaul operation again after 2 years and 4 years respectively, due to small right ventricular cavity and obvious cyanosis. 14 patients were followed up with good right ventricular development, and then biventricular repair operation was performed. Six patients were still with following up.After the first operation, the peripheral oxygen saturation and activity

关 键 词：右心室发育不良 双心室根治 右心室Overhaul 

分 类 号：R654.2[医药卫生—外科学]