主动脉弓阻塞合并心脏畸形18例的一期矫治

目的总结一期矫治主动脉弓阻塞合并心脏畸形的诊治经验。方法2005年1月至2006年6月一期矫治18例主动脉弓阻塞合并心脏畸形。其中主动脉弓中断(IAA)6例,主动脉缩窄(COA)12例。手术均为正中开胸低温体外循环下一期畸形矫治术。结果手术采用降主动脉与主动脉弓端端吻合11例,端侧吻合6例,Gore-Tex片加宽弓成形1例。围术期死亡1例,总死亡率5.56%。喉返神经损伤2例,术后左主支气管受压1例。随访1～11个月,1例上下肢压差25mmHg,6例压差小于20mmHg,7例端侧吻合无压差。存活者无症状,生长发育良好。结论正中开胸一期矫治COA及IAA合并心脏畸形可获得满意的近期疗效。手术成功的关键是充分游离降主动脉,尽可能行端侧吻合术。

One-stage correction of aortic arch obstruction associated with cardiac anomalies in 18 cases

Objective To summarize the experience of one-stage repair of aortic arch obstruction associated with cardiac anomalies. Methods Between January 2005 and June 2006, eighteen pediatric cardiac patients underwent one-stage correction of interrupted aortic arch (IAA, 6 cases) and coarctation of the aorta(COA,12 cases). All procedures were median sternotomy under cardiopulmonary bypass. Results The aortic arch reconstruction were end-to-end anastomosis between the descending aorta and the arch in 11, end-to-side anastomosis in 6, and one case was enlargement with Gore-Tex patch. There were 1 death (overall mortality 5.56%). The recurrent laryngeal nerves injuries in 2, the left main bronchial compression in 1. All survivors were followed up for 1 to 11 month. There were no pressure gradient between upper limb and lower limb in 7, pressure gradient less than 20 mm Hg in 6, one case had residual gradient(25 mm Hg). All survivors are asymptomatic and are developing normally. Conclusion One-stage complete correction of IAA and COA with cardiac anomalies through median sternotomy yields excellent intermediate surgical results. The key of operation is extensively dissection of the descending aorta and aortic reconstruction was end-to-side anastomosis.