63例心房室管畸形的外科治疗

目的:总结心房室管畸形外科治疗的经验。方法:我院自2005年5月至2009年12月手术治疗心房室管畸形患者63例。其中部分性房室管畸形56例,完全性房室管畸形7例。部分性房室管畸形瓣裂修补采用间断褥式缝合并连续缝合加固;原发孔型房间隔缺损24例采用Kirklin的方法修补将冠状静脉窦开口隔入左心房,32例采用McGoon法冠状静脉窦开口保留在右心房。完全性房室管畸形7例。按Rastalli分型属A型4例,C型3例,分别采用自体心包加涤纶片的双片法(4例)或自体心包单片法(3例)修复。合并畸形均予以同期处理。结果:无早期死亡病例。术后发生低心排出量综合征(低心排)8例;Ⅲ°房室传导阻滞1例,7d后恢复窦性心律。术后随访46例,随访时间2个月～4年,心功能均为Ⅰ～Ⅱ级。结论:部分性房室管畸形手术治疗的关键,是完善修复二尖瓣关闭不全和避免房室传导阻滞。完全性房室管畸形除注重房室瓣修补完善外,强调将二尖瓣和三尖瓣环纠正至正常解剖位置,以恢复室间隔的面积和增宽左心室流出道。     

房室隔缺损的手术治疗

目的 :总结 2 1例房室隔缺损 (atrioventricularseptaldefect,AVSD)手术治疗经验。方法 :2 1例中部分型 (PAVSD) 8例 ,中间型 (MAVSD) 7例 ,完全型 (CAVSD) 6例。二尖瓣大瓣裂缺以 5 - 0聚丙烯线来回连续缝闭 ,必要时行二尖瓣或三尖瓣成形。原发孔房间隔缺损以新鲜自体心包片修补 ,将冠状窦口隔入右房。CAVSD6例中 ,4例按McGoon氏“单片法”修补 ,2例用“双片法”修补。结果 :PAVSD及MAVSD无手术死亡 ,仅 1例CAVSD根治术后早期死于严重低心排 ,死亡率 4 8%。术后随访二尖瓣中度返流 1例 ,轻度返流 4例。全组病人术后无Ⅲ°房室传导阻滞 ,左室流出道狭窄及房、室缺残余漏。结论 :PAVSD及MAVSD如无肺高压、严重二尖瓣返流及左室流出道狭窄 ,手术可在 3岁以后进行 ,否则应尽早手术。而CAVSD由于大量左向右分流和房室瓣返流 ,大多数患儿 6～ 12个月即出现肺血管阻塞性病变 ,应在肺血管病变发生前行根治术。     

房室间隔缺损二尖瓣反流的手术治疗

目的总结先天性心脏病房室间隔缺损二尖瓣关闭不全的二尖瓣成形手术方法和临床效果。方法84例房室间隔缺损患者中,完全性房室间隔缺损9例、过度性房室间隔缺损21例、部分性房室间隔缺损54例。二尖瓣关闭不全的主要病理改变为瓣叶裂隙84例、瓣环扩大41例。二尖瓣成形方法为瓣叶裂隙缝合78例、交界环缩26例、瓣环环缩7例、双孔法2例等。术中左心室注水观察、评价成形后二尖瓣反流程度,脱离体外循环后食管超声心动图观察成形结果。结果全组死亡1例,1例因术后血尿行二尖瓣置换术。术后门诊随访,二尖瓣反流0￣Ⅰ级反流58例,Ⅱ级11例;术后随访,左心房、左心室缩小,与术前比较差别有统计学意义。结论房室间隔缺损二尖瓣关闭不全除瓣叶裂隙需要缝合外,还要矫正扩大的瓣环,术中注水试验和食管超声能为判断手术效果提供帮助。     

完全性房室间隔缺损修补术后随访分析

目的 探讨完全性房室间隔缺损修补术的疗效.方法 对2003年1月至2006年6月行完全性房室间隔缺损修补术患儿进行随访分析.通过超声心动图心尖四腔切面评估术前,术后第2天、1个月、6个月及1年的房室瓣反流程度.大于6个月患儿术前行心导管检查了解肺动脉压力及肺小动脉阻力(PAR).记录术后监护时间、呼吸机使用时间及肺动脉高压危象发生情况.结果 105例完全性房室间隔缺损患儿术后监护(4.7±2.4)d,呼吸机使用(1.7±1.0)d,出现肺动脉高压危象9例(8.5%).PAR>8 Wood单位患儿与PAR≤8 Wood单位患儿比较,年龄较大,术后监护时间、呼吸机维持时间较长,肺动脉高压危象发生率较高(均P<0.05).院内死亡4例(3.8%),其中3例的共同瓣严重发育不良.与术前比较,术后左侧及右侧房室瓣反流均明显减轻(P<0.05).81例(77.1%)患儿术后瓣膜反流程度稳定,14例(13.3%)患儿术后反流程度逐渐加重,10例(9.6%)患儿术后反流程度逐渐减轻.结论 完全性房室间隔缺损早期修补术安全、有效.术前PAR>8 Wood单位患儿术后易出现肺动脉高压危象.     

室间隔缺损修补术致希氏束自律性心动过速1例

患儿女性,2岁.临床诊断:先天性心脏病,室间隔缺损.1998年11月2日在我院全麻低温体外循环下行室间隔缺损修补术.术中切开右心房,经三尖瓣口见室间隔缺损位于膜部,缺损被三尖瓣隔瓣遮盖后,遗留4×4mm的分流口.带垫片褥式缝合一针闭合室间隔缺损.心脏自动复跳,表现为完全性房室传导阻滞.再次阻断主动脉,拆除原来缝线,垂直三尖瓣环切开三尖瓣隔瓣,暴露原发室间隔缺损,加垫片褥式缝合两针闭合室间隔缺损.心脏复跳后仍为     

部分型心内膜垫缺损的手术治疗（附56例报告）

目的总结部分型心内膜垫缺损的手术治疗经验。方法56例部分型心内膜垫缺损患者均采用间断缝合修复二尖瓣前瓣裂。原发孔房间隔缺损采用自体心包片或涤纶片修补。并发其他畸形者同期处理。结果无手术死亡。3例复跳后出现Ⅲ度房室传导阻滞,再次阻断主动脉,拆除心包片,重新缝合,未见传导阻滞;余53例未见手术并发症。随访3个月-12 a,二尖瓣轻度反流2例,三尖瓣轻度反流3例。结论手术治疗部分型心内膜垫缺损疗效满意,手术成功的关键在于修补二尖瓣裂和原发孔缺损,避免残余漏。术中应注意避免传导束损伤。     

5例完全性房室间隔缺损的外科治疗

报告５例完全性房室间隔缺损的外科治疗．５例均为ＲａｓｔｅｌｌｉＡ型，３例合并重度肺动脉高压；在中度低温体外循环下根治手术，早期死亡１例．随访２月～４年，无晚期死亡，３例恢复良好，ｌ例合并中～重度二尖瓣返流及中度肺动脉高压．作者主张尽早在婴儿期行根治术，术中精确修补室间隔缺损及原发孔房间隔缺损，精确重建二尖瓣功能防止术后二尖瓣返流，加强术后肺动脉高压的处理。     

经右胸先天性心脏缺损修补术的体会

自 1 994年 8月至 2 0 0 0年 3月 ,我们采用经右胸前外侧切口径路 ,在体外循环下行房、室间隔缺损修补手术 374例 ,取得良好的效果 ,现报告如下。1　资料与方法1 .1　临床资料　 374例中 ,男 2 0 0例、女 1 74例 ,年龄 1～ 55岁 ,体重 1 0～ 74kg。其中继发孔房间隔缺损1 81例 (上腔型 1 7例 ,中央型 1 2 2例 ,下腔型 42例 ) ,合并部分型右肺静脉异位引流 1 2例 ;原发孔房间隔缺损伴二尖瓣裂 1例 ;室间隔缺损 1 92例 ,均为膜周部缺损。1 .2　手术方法　麻醉后患者平卧 ,右胸抬高 45°,右上肢屈肘悬吊于手术台支加上。取右胸前外侧切口 ,女性…     

国产封堵器介入治疗先天性心脏病53例

目的总结心健^TM封堵器介入治疗房间隔缺损、动脉导管未闭及室间隔缺损的可行性及疗效。方法病人年龄11个月～45岁,体重5～66奴。在X线透视及经胸超声心动图监视下,应用心健^TM封堵器按常规方法行介入封堵术,治疗房间隔缺损29例、动脉导管未闭23例、室间隔缺损合并房间隔缺损1例。房间隔缺损均为继发孔中央型;动脉导管未闭漏斗型9例、管型13例、窗型1例;室间隔缺损为膜周型。结果全组无死亡。即刻成功率98％（52／53）,即刻完全封堵率92％（48／52）。1例窗形动脉导管未闭并重度肺动脉高压术后血尿,经药物治疗4日后症状消失;另术后早期少量残余分流3例,Ⅰ度房室传导阻滞4例,Ⅱ度Ⅰ型房室传导阻滞1例,随访1～6个月症状均消失。结论用心健^TM封堵器介入治疗房间隔缺损、动脉导管未闭及室间隔缺损可靠,疗效确切。     

部分房室隔缺损的外科治疗

目的 :总结部分房室隔缺损外科治疗的经验及效果。方法 :部分房室隔缺损病人 2 75例 ,年龄 9个月～ 6 0岁 ,平均 ( 14 4± 11 1)岁。男性 117例 ,女性 15 8例。术中见均有较大的原发孔缺损呈半圆形 ,二尖瓣裂隙为完全性的 179例 ,部分的为 81例 ,有二尖瓣双开口 1例。合并畸形有卵圆孔未闭4例 ,继发孔房间隔缺损 (房缺 ) 2 5例 ,左上腔静脉 4例 ,主动脉瓣下膜样狭窄 2例 ,动脉导管未闭 1例 ,单心房 2例 ,三房心 1例。所有病人均修复二尖瓣裂隙 ,以心包修补原发孔房缺。结果 :早期死亡 11例 ,4 %。晚期死亡 5例。其余病人经 6个月到 2 5年随诊 ,其中心功能已达Ⅰ级 2 0 6例 ,Ⅱ级 5 2例。晚期重度二尖瓣关闭不全 2例 ,行二尖瓣替换。Ⅲ度房室传导阻滞 6例 ,Ⅱ度房室传导阻滞 3例。结论 :对于部分房室隔缺损的病人一经发现需尽早手术治疗 ,妥善修复二尖瓣裂隙 ,严密闭合原发孔房缺 ,防止传导阻滞的发生 ,尽量修复三尖瓣关闭不全是取得良好远期效果的关键。     

心脏不停跳对中老年房间隔缺损患者术后恢复的作用

目的：探讨体外循环下心脏不停跳对中老年继发孔型房间隔缺损患者术后恢复的作用。方法：对19例中老年继发孔型房间隔缺损患者在体外循环心脏不停跳情况下行房间隔缺损修补术，同时有10例行三尖瓣Devage成形术，3例行二尖瓣成形术。结果：19例患者术后全部生存，心功能明显改善，总有效率89％。结论：心脏不停跳有利于中老年房间隔缺损术后恢复。     

Complete atrioventricular canal repair with a decellularized porcine small intestinal submucosa patch

Background: Congenital heart defects affect nearly 1% of all children born per year in the United States, and complete atrioventricular canal (CAVC) accounts for 2%‐9%. While several patch materials have been used for septal defect closure during CAVC repair, clear superiority of one material over another has yet to be established.
Methods: A retrospective review of clinical outcomes following CAVC repair at Morgan Stanley Children’s Hospital/Columbia University was performed on opera‐ tions conducted from March 2010 to September 2017. Univariate and Kaplan‐Meir survival analyses were utilized to evaluate primary outcomes of interest following CAVC repair in the modern surgical era.
Results: A total of 73 patients were analyzed, with an average operative age of 22 weeks. The majority (71%) of the patients underwent a 2‐patch repair. A CorMatrix patch was used for ventricular septal defect(VSD) closure in 77% of the patients, and/or in 75% of atrial septal defect closures. There was one in‐hospital mortality (1.4%) due to respiratory failure. One patient required a pacemaker. At mid‐term fol‐ low‐up (1.6 years), a total of 7 patients required 8 reoperations due to cardiac‐related indications, including 5 for left atrioventricular valve (LAVV) repair, 1 for LAVV re‐ placement, and 2 isolated residual VSDs.
Conclusion: A standardized repair for CAVC results in excellent outcomes in the cur‐ rent era, with low rates of reoperations. CorMatrix for the closure of CAVC has proven to produce good results with equivalent outcomes to other patch materials. Its ease of use and pliability make it an attractive alternative for consideration.     

腹部三维超声成像技术检查心脏的可行性研究

目的探讨腹部三维超声成像技术应用于非胎儿心脏检查的可行性及其应用价值。方法在常规二维超声心动图检查基础上,应用具有腹部三维超声成像功能的彩超仪的腹部三维超声探头对28例二尖瓣狭窄与16例房间隔缺损患者(11例儿童和5例成人)的心脏进行三维超声成像,记录二尖瓣最大开放面积与房间隔缺损最大径,并同手术测值和常规二维超声心动图测值进行对比分析。结果腹部三维超声成像技术可以直观地显示二尖瓣狭窄与房间隔缺损的立体形态特征,所测二尖瓣最大开放面积与房间隔缺损最大径同手术测值(r=0.81和r=0.89)和常规二维超声心动图测值(r=0.79和r=0.85)相关性良好,超声与手术方法测值比较差异无统计学意义(P>0.05)。结论腹部三维超声成像技术可以应用于大多数儿童与部分成人的心脏检查,是对常规二维超声心动图的有益补充。     

经胸房间隔缺损堵闭术对房室瓣反流的影响

目的探讨经胸房间隔缺损封堵术对房室瓣反流的影响。方法回顾性分析2002年1月至2011年3月在南方医科大学珠江医院经胸微创房间隔缺损堵闭术患者的临床资料,其中资料完全者43例,40例在食道超声、2例在经胸超声辅助下行房间隔缺损堵闭术。患者术前、术后1个月及6个月经超声心动图检查,观察心脏各指标的变化和房室瓣反流程度。结果41例手术成功,手术成功率95．3％（41／43）;1例术中改为右侧开胸小切口体外循环下房间隔缺损修补术,1例术中并发心搏骤停。1例术后并发肾功能衰竭：12例术后即时有少量残余漏,1个月后超声复查消失。术后超声随访显示：右心室、右心房直径较前缩小,左心室直径较前增大,肺动脉瓣血流速度明显降低,差异有统计学意义（P〈0．05）;室间隔厚度、二尖瓣血流速度、主动脉瓣血流速度无明显改变,差异无统计学意义（P〉0．05）。房间隔缺损堵闭术后1个月、6个月,二尖瓣瓣膜反流程度较术前加重,差异有统计学意义（平均秩次：2．01VS．2．17vs1．77,x2=10．78,P=0．04）;而三尖瓣的瓣膜反流程度术前与术后1个月、6个月比较,差异无统计学意义（平均秩次：1．88vs2．11US．2．01,X2=4．23,P=0．134）。结论房间隔缺损封堵术后,可引起二尖瓣反流程度的加重,但对三尖瓣的反流程度近期影响不明显;二尖瓣中度以上或三尖瓣重度反流的患者或不适宜行单纯房间缺损封堵术。     

Stenotic double-orifice mitral valve after surgical repaired partial atrioventricular septal defect

Double-orifice mitral valve (DOMV) is an uncommon congenital anomaly account for 1% of congenital heart disease. However, accurate diagnosis and evaluation of valve stenosis or regurgitation and other concomitant congenital anomalies due to DOMV are required to obtain suitable treatment. Two- and three-dimensional echocardiography can contribute valuable functional and anatomic information that can support to reach this goal. Here, we present a case of complete bridge-type DOMV that causes mitral stenosis after surgical repair of the partial atrioventricular septal defect in childhood.     

Atrioventricular septal defect with a well developed primary component of the atrial septum ("septum primum")

A heart is described with an atrioventricular septal defect in which the lower part of the atrial septum ("septum primum") was well developed and in which superior and inferior bridging leaflets were attached neither to the crest of the ventricular septum nor the inferior rim of the atrial septum. Diagnostic pre-operative angiographic and echocardiographic features and the method of surgical correction are outlined.     

Two‐step approach of percutaneous closure of a paravalvular leak and atrial septal defect after mitral valve reoperation

Severe paravalvular leakage following mitral valve replacement, a rare but potentially serious complication, may result in heart failure and significant hemolysis. Reoperation is considered standard of care. However, in selected patients, re‐do sternotomy carries excessively high surgical risk. Percutaneous closure of paravalvular leaks has become a viable option for these patients. We present a case of a highly symptomatic 42‐year‐old male who underwent successful percutaneous closure of two paravalvular leaks and a post‐operative atrial septal defect after re‐do mitral valve replacement surgery. As access to the left atrium was expected to be difficult following percutaneous atrial septal defect closure, a two‐step approach of paravalvular leak closure followed by atrial septal defect closure was chosen. Difficulties of atrial septal defect closure following closure of a paravalvular leak next to the inter‐atrial septum will be discussed. © 2011 Wiley‐Liss, Inc.     

Complications Related to Transcatheter Occlusion of Atrial Septal Defect with Amplatzer Septal Occluder in Children

METHODSPatients From August 1998 to March 2004, a total of 289 children (mean age: 6.5 ±3.8 years) have undergone transcatheter occlusion of secundum type ASD with ASO. All cases performed transthoracic echocardio- graphy (TTE) evaluation before implantation and con- finned by balloon sizing in interventional procedure, partly confirmed by transoesophageal echocardiography(TEE). Patients with a residual rim of atrial septum <4mm, or diameter of ASD + 14mm > the maximal septal length…     

Left Ventricular to Right Atrial Septal Defect Secondary to Blunt Thoracic Trauma Diagnosed by Transesophageal Echocardiography

A case report is presented of a 58-year-old man who developed a new holosystolic murmur 4 months after a high-speed motor vehicle accident. Cardiac catheterization demonstrated a left-to-right shunt at the right atrial level. Intraoperative transesophageal echocardiography (TEE) identified and localized a discrete atrioventricular septal defect associated with a shunt from the left ventricle to the right atrium without tricuspid regurgitation, findings that were confirmed after surgical exploration. TEE is recommended for patients with a heart murmur and a history of blunt cardiac trauma, may permit early diagnosis, and may allow surgical repair in selected patients without pre-operative catheterization. (ECHOCARDIOGRAPHY, Volume 8, May 1991)