手术治疗婴幼儿主动脉缩窄32例分析

目的总结32例婴幼儿主动脉缩窄的外科治疗经验。方法手术治疗婴幼儿主动脉缩窄(CoA)32例。单纯主动脉缩窄7例,合并动脉导管未闭(PDA)17例,合并心内畸形的25例,合并主动脉弓发育不良1例。采用正中胸骨切口或左侧切口,手术方法包括缩窄段切除主动脉端端或端侧吻合24例;纵行切开缩窄段,心包片加宽成形7例;1例应用锁骨下动脉片翻转法。结果死亡3例,29例患儿顺利出院,上下肢压力差消失,其中25例随诊3个月～3年,2例出现主动脉轻度狭窄。无其他并发症。结论婴幼儿主动脉缩窄的外科治疗可获得良好的近中期疗效,合并心内畸形的患儿大部分可采取正中切口一期手术。

SURGICAL MANAGEMENT FOR COARCTATION OF AORTA IN NEONATES AND INFANTS

Objective To evaluate the surgical effect for 32 neonates and infan patients with coaretation of aorta(CoA) in.Methods In 32 cases CoA for surgical treatment,there were 7 cases of simple CoA and 17 cases of PDA.There were 25 cases for CoA with other associated cardiac anomalies.One patient had hypoplasia of the aortic arch.With median sternotomy or left incision,operational techniques for aortic coarctation include 24 patients of resection and end-to-end or end-to-side anastomosis,7 patients of patch aortoplasty,1 patient of subclavian flap aortoplasty.Results There were 3 patients died,the mortality rate was 9.38%,29 patients were discharged,the pressure difference between upper and lower limbs disappeared.25 cases were followed up for 3 months to 3 years,2 of them had mild aortic stenosis.No other complications.Conclusion Surgeries for aortic coarctation have satisfactory recent mid-term effect for neonates and infants.One-stage repair through median stemotomy can be applied to most of the patients with intracardiac anomaly.