单向活瓣补片在合并重度肺动脉高压的先天性心脏病患者手术治疗中的应用

目的探讨应用单向活瓣补片对合并重度肺动脉高压的先天性心脏病(先心病)患者的手术治疗方法及效果.方法采用单向活瓣补片对38例伴有重度肺动脉高压的先心病患者进行手术治疗及术后随访观察.结果术后11例肺动脉压力下降明显,未出现跨单向活瓣补片的分流;余27例术后72 h内出现分流,其中1例术后72 h死于低心排出量,1例术后4周死于右心衰竭;36例康复出院.术后出现分流的27例患者22例随访6～86个月,其中术后3个月仍出现跨单向活瓣补片分流7例,右向左分流4例,双向分流3例;术后半年以上仍存在经单向活瓣补片分流4例,其中3例肺动脉收缩压(PP)/主动脉收缩压(PS)仍>0.75,2例右向左分流,1例双向分流;另1例PP/PS降至0.45,存在3 mm跨单向活瓣补片左向右分流;11例术后未出现跨单向活瓣补片分流者,术后3个月复查示肺动脉压力下降满意,无跨单向活瓣补片分流.22例中19例自觉症状及生活质量较术前改善明显.结论对于合并重度肺动脉高压的先心病应用单向活瓣补片进行手术修补,可使当术后右心压力增高时右心血流可通过单向活瓣补片活瓣孔分流到左心系统,为右心起到分流减压作用,同时以可以耐受的体循环血氧饱和度降低为代价增加左心系统血容量,保证左心排出量,以达到保持体肺循环相对平衡,使患者能度过术后危险时期,减少围术期死亡的效果.

Application of one-way valved patch in treatment of patients with congenital heart disease with severe pulmonary hypertension

OBJECTIVE: To explore the effect of one-way valved patch used in congenital heart disease with severe pulmonary hypertension. METHODS: One-way valved patch was used in 30 patients of congenital heart disease with severe pulmonary hypertension (PP/PS > 0.75) in operation. Follow-up of 6 approximately 86 months was conducted to observe its effect. RESULTS: The pulmonary artery pressure was significantly decreased without trans-patch shunt in 11 cases postoperatively. Trans-patch shunt was determined in 27 cases within postperative 72 hours. There were 2 postoperative deaths out of these 27 patients: one died of low cardiac output syndrome 72 hours after operation, and the other died of right heart failure 4 weeks after operation. Thirty-six patients were restored to health and discharged. Three-month follow-up showed trans-patch shunt in 7 cases, including right-to left shunt in 4 cases and two-side shunt in other 3 cases. Color Doppler ultrasonography conducted 6 months after operation proved trans-patch shunt in 4 cases, right-to-left shunt in 1 case, two-side shunt in 2 cases, and left-to-right shunt in 1 case (PP/PS = 0.45). CONCLUSION: One-way valved patch is useful in selected patients in which postoperative right heart failure can be anticipated so as to shunt the blood in the right heart to the left heart and increase the blood volume in the left heart system to ensure the left heart output and minimize the risk of postoperative right heart failure, at the expense of systemic low oxygen saturation that is, however, well tolerated.