心脏不停跳加单向活瓣补片法在合并重度肺动脉高压先心病手术中的应用

目的探讨心脏不停跳加单向活瓣补片法在合并重度肺动脉高压先心病手术中的应用。方法13例合并重度肺动脉高压先心病患者采用心脏不停跳加单向活瓣补片法手术治疗,对手术适应证的把握,围术期的处理,特别是术中采用心脏不停跳方法应注意的问题进行分析。结果全组均顺利脱离体外循环机,无空气栓塞并发症。1例室缺患者并发肺部感染死亡。其余患者均于术后2~5 d脱离呼吸机顺利恢复。术后1周复查心脏彩超9例无分流,Pp/Ap为0.45~0.63。3例有右向左单向分流,Pp/Ap为0.76~0.82。术后3个月复查仅1例存在分流,Pp/Ap为0.74,术后6个月分流消失。12例生存患者术后生活质量明显提高,心功能为Ⅰ~Ⅱ级。结论采用心脏不停跳加单向活瓣补片法拓宽了治疗合并重度肺动脉高压先心病的适应证,同时极大程度地降低了术中的心肌损伤,取得了良好的心肌保护效果,为患者安全度过围术期提供了保障。

Application of Beating Heart and One-way Valved Patch in Treatment of Patients with Congenital Heart Disease with Severe Pulmonary Hypertension

Objective To explore the application of beating heart and one-way valved patch in treatment of patients with congenital heart disease with severe pulmonary hypertension.Methods Beating heart and one-way valved patch were used in 13 cases of patients with congenital heart disease with severe pulmonary hypertension.The treatment with operation indication and perioperative positioning,especial during operation,used the method of beating heart to analyse the problems should be pay attention to.Results All patients had been removed of cardiopulmonary bypass(CPB),without any complication of air embolism.Dispite of 1 case with ventricular septal defect died of respiratory infection,all remained cases were removed of CPB and recoved smoothly in 2-5days after operation.Colour Doppler ultrasonography conducted 1 week after operation showed that there are 9 cases with no shunt,Pp/Ap:0.45-0.63;3 cases with right to left one-way shunt,Pp/Ap:0.76-0.82,Only 1 case had right to left shunt 3 months after operation,its Pp/Ap was 0.74,6 months after operation had not shunt.All survivals had good living quality,and New York Heart association functional classification were ClassⅠ-Ⅱ.Conclusion Application of the beating heart and one-way valved patch expended the opearating indication of congenital heart disease with severe pulmonary hypertension,meanwhile,it minimized myocardial injury,won a good effect on myocardial protection,ensured patients passing perioperation safely.