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1.
同种带瓣主动脉和带瓣肺动脉补片在儿童复杂先心病的应用 总被引:9,自引:1,他引:9
1989年11月至1992年7月期间,应用低温保存同种带瓣大动脉纠治儿童复杂性先心病12例。病人年龄2~16岁(7.2±3.7岁),体重8~31.5kg(18.9±6.6kg)。诊断为法乐氏四联症(TOF)8例,其中伴肺动脉瓣闭锁3例;冠状动脉畸形1例;严重肺动脉发育不良2例;左肺动脉缺如2例。大动脉错位伴室间隔缺损和肺动脉狭窄2例;永存动脉干畸形(Ⅱ型)2例。8例应用同种带瓣管道作右室流出道与肺动脉连接,4例应用同种带瓣肺动脉片作跨瓣环右室流出道扩大术。本组死亡1例,最长随访时间3年。文中对同种带瓣管道的取材方法,保存技术及应用方法作了讨论。 相似文献
2.
目的回顾性总结手术纠治45例完全性房室隔缺损(completeatrioventriculardefect,CAVD),以期把握好手术时机,提高手术成功率和生存质量。方法根据Rasteli分型:A型26例,B型2例,C型2例,过渡型15例。手术采用单片心包补片修补方法。结果手术死亡3例,死亡率6.7%。死亡原因为伴发心内严重畸形法洛四联症2例,重度肺动脉高压1例;远期死亡2例,均为二尖瓣反流并发肺部感染和心力衰竭。结论CAVD早期出现肺动脉高压,手术应在6个月~1岁内为好,术后必须定期随访,早期了解房室瓣反流情况 相似文献
3.
自体肺动脉连接右心室纠治婴儿永存动脉干 总被引:3,自引:1,他引:2
目的 评估自体肺动脉连接右心室方法纠治婴儿永存动脉干的疗效。方法 2 0 0 1年 11月至 2 0 0 2年 7月 ,5例病婴采用自体肺动脉连接右心室方法纠治永存动脉干。 5例病婴为 2~ 9月龄 ,体重 3 5~ 8 0kg ,平均 (5 5± 1 6 )kg。永存动脉干I型 3例 ,II型 2例。结果 手术无死亡。术后随访 10~18个月 ,超声心动图显示室间隔缺损修补后无残余分流 ,肺动脉至右室流出道无残余梗阻 ,除 1例共同瓣轻度反流 ,余 4例均无明显反流。结论 自体肺动脉直接连接至右心室切口 ,完全由自体组织连接 ,使其能生长 ,不引起远期梗阻或狭窄 ,避免了再次手术的痛苦和危险 ,是较为理想的手术方法。但手术时间尚短 ,仍需进一步随访。 相似文献
4.
同种带瓣大动脉在重建右室流出道中的应用 总被引:7,自引:0,他引:7
应用自行采集和冷冻保存的同种带瓣大动脉(VHC)为50例复杂先心病病儿重建右室流出道,观察其疗效及存在的问题。本组50例,年龄14个月~16岁(5.9±3.2岁)。包括17例完全性大动脉错位、7例右室双出口、5例永存动脉干和21例法乐四联症。主动脉VHC应用于42例(裁剪成2瓣VHC4例),肺动脉VHC应用于2例,单瓣肺动脉作为补片扩大RVOT5例,同种无名动脉架桥于RVOT1例。结果:术后住院死亡7例。35例随访1个月~7年,晚期死亡2例,均为感染。1例II型PTA病儿术后3年半发生心内膜炎,手术清除VHC瓣膜处赘生物,仍存活。33例长期生存者中5例X线胸片示VHC有钙化,均为主动脉材料,仅1例有轻度压力阶差。结论:VHC可广泛应用于复杂先心病。VHC的长期通畅比合成管道好,肺动脉VHC优于主动脉VHC。为预防植入后VHC的感染,应重视和改进VHC的收集、保存和应用过程中的预防感染措施 相似文献
5.
先天性永存动脉干的外科治疗 总被引:2,自引:1,他引:1
报道1989年1月至1993年12月外科治疗先天性永存动脉干6例。按VanPraagh分型,I型2例、II型4例。I型中伴主动脉弓中断1例,按Celoria等分类为A型。伴其它心内畸形3例。手术在中度低温体外循环下进行,其中1例采用深低温停循环技术处理主动脉弓中断。手术5例成功,随访7个月~4年8个月,疗效良好。1例术后肺动脉高压并发感染,自动出院后失访。作者主张永存动脉干一旦确诊宜早期手术。并对I型、II型的手术方法,肺动脉高压的治疗作了分析探讨。 相似文献
6.
连续115例小儿法乐四联症外科治疗无手术死亡经验 总被引:14,自引:0,他引:14
目的:总结连续115 例小儿法乐四联症根治术无手术死亡经验。方法:115 例法乐四联症病儿,9 月龄~13 岁,平均(4 .6 ±2 .7) 岁,3 岁以下55 例,合并有肺总动脉或一侧肺动脉闭锁4 例,肺动脉瓣缺如1 例,合并房间隔缺损和动脉导管未闭11 例。全部病儿均施行根治手术,用dacron 补片修补室间隔缺损,用自体心包作右室流出道及肺动脉扩大,102 例(89 % ) 作了跨瓣环补片。结果:全组无手术死亡。随访2 ~48 个月,术后3 个月1 例死于心律紊乱,其余均恢复良好。结论:提高小儿法乐四联症根治术成功率的关键是:改进手术方法,彻底解除右室流出道及肺动脉远端梗阻,选用适当的转流技术和重视术后监测。 相似文献
7.
小儿永存动脉干外科诊治19例 总被引:5,自引:0,他引:5
目的 总结19例小儿永存动脉干(PTA)外科治疗的经验。方法 1989年1月至2002年6月外科手术纠治19例PTA。病儿2月龄~5岁;体重3.5—16.0kg。按Van Praagh分型,A1型8例,A2型9例,A3及A4型各1例。右室-肺动脉流出道重建用涤纶生物瓣管道和同种带瓣肺动脉各2例,同种带瓣主动脉11例,近1年的4例未用外管道。结果 手术死亡率10.5%(2,19例)。晚期死亡1例。结论 PTA易早期并发肺血管梗阻性疾病,应在1岁以内行纠治术。手术需防止室间隔缺损残余分流;离断肺动脉和修复动脉干缺损时,应避免损伤动脉干、瓣膜及冠状动脉口;如条件许可,A1型及A2型可不用外管道重建右室-肺动脉流出道,避免了因更换管道而再次手术。 相似文献
8.
目的将同种带瓣主动脉经过适宜处理后,用以治疗18例合并肺动脉狭窄的矫正型大动脉转位(CTGA)患者,其中内脏正位(SLL)型14例,内脏反位(IDD)型4例,均合并室间隔缺损(VSD)。方法手术缝闭肺动脉瓣口,修复VSD,用经过冷冻处理的同种带瓣主动脉管道连接功能右心室和肺动脉。结果术后测压:右心室收缩压为3.3~6.4kPa(25~48mmHg),右心室-肺动脉压差0.66~3.0kPa(5~22mmHg),右心室/左心室压比值0.3~0.6。结论采用同种带瓣主动脉能使患者术后血流动力学指标更接近于人体正常生理状态。 相似文献
9.
目的 总结小儿永存动脉干(PTA)右室流出道重建治疗经验.方法 2000年1月至2007年12月共行PTA根治手术治疗43例,男26例,女17例.年龄1.5个月~3.8岁;体重3.2~23.0kg.Ⅰ型、Ⅱ型和Ⅲ型PTA分别为26例、11例和6例.18例PTA的肺动脉直接下拖至右室流出道切口上缘相吻合,前壁再用心包补片扩大;8例用Homograft管道、14例用牛颈静脉管道连接远端肺动脉和右心室,重建右室流出道;3例Ⅱ型者,肺动脉后壁用左心耳壁与右室流出道上缘做吻合,前壁再用心包补片扩大.结果 术后所有病儿均生存,5例表现为右心功能不全,2例右肺动脉(RPA)压差37.5~47.3 mm Hg(1mm Hg=0.133kPa),术后17d恢复至35.3mm Hg以下.左心室流出道阶差均小于20.3mm Hg.残余VSD(2mm)1例,乳糜胸1例.5例病儿肺血管阻力高,吸一氧化氮(NO)治疗7d左右后好转.随访3个月~3年,2例病儿RPA残余压差24.0~29.3 mm Hg,均无明显右心室或左心室流出道梗阻.结论 肺总动脉后壁直接与右心室切口作吻合重建PTA的右室流出道,早期和远期效果良好.牛颈静脉的带瓣管道的应用,解决了小尺寸同种带瓣管道来源不足的问题,操作简便. 相似文献
10.
矫正型大动脉转位伴心脏畸形外科治疗 总被引:2,自引:0,他引:2
自1985年9月至1994年3月手术治疗33例矫正型大动脉转位伴心脏畸形病人,其中男21例,女12例,年龄1~35岁(平均11岁)。其中SLL型31例,IDD型2例,手术修复室间隔缺损28例,肺动脉狭窄29例(14例应用外带瓣管道,其中9例同种主动脉带瓣管道,5例为带戊二醛处理的猪肺动脉瓣的人工管道),修补房间隔缺损15例,左侧房室瓣关闭不全成形2例,动脉导管未闭缝合和改良Fontan手术各1例。 相似文献
11.
H Yaku T Yagihara H Kishimoto F Isobe F Yamamoto K Nishigaki T Fujita O Takahashi T Kamiya Y Naito 《[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai》1992,40(8):1182-1188
Total repair for truncus arteriosus using an external conduit was performed in 12 patients from 1978 through 1989. Six cases were infants (mean age: 3.4 months) and 6 were children (mean age; 1 years 9 months). Two cases had Collet-Edwards type II truncus and the other 10 cases had type I truncus. One of the infants was associated with an interruption of the aorta and another had a severe regurgitation of the truncal valve (TrV). For external conduits, we used a non-valved conduit in one infant, a composite valved conduit of Dacron containing a heterograft valve in 4 children and a valved pericardial roll made of an autologous or porcine pericardium in 5 infants and 2 children. One infant with a severe regurgitation of the TrV needed valve replacement along with enlargement of the annulus of the TrV. One infant who had replacement of the TrV died early postoperatively. Another infant died 10 months after total repair due to an infection of an external conduit. Cardiac catheterization was performed in all 10 survivors. The mean value for the systolic pulmonary/systemic pressure ratio decreased from 0.98 +/- 0.09 preoperatively to 0.36 +/- 0.09 postoperatively. Replacement of an external conduit was performed due to a conduit stenosis in 2 children and 1 infant, 10 years and 2 months, 7 years and 9 months, and 1 year and 8 months after the total repair, respectively. In one of these 2 children, replacement of the aortic valve was performed due to a severe aortic regurgitation. We conclude that our results of total repair for truncus arteriosus were satisfactory. However, it remains to be solved how to manage an infant with truncus arteriosus associated with a severe regurgitation of the TrV. 相似文献
12.
R C Elkins J B Steinberg J D Razook K E Ward E D Overholt W M Thompson 《The Annals of thoracic surgery》1990,50(5):728-733
Surgical correction of truncus arteriosus requires the creation of right ventricular to pulmonary artery continuity and closure of the ventricular septal defect. A variety of conduits have been used including valved and nonvalved. Despite a significant incidence of truncal valvar stenosis and insufficiency, this valve has seldom been replaced. We present 4 cases of truncus arteriosus with truncal valvar stenosis or insufficiency that were repaired using two valved homografts: one to create the pulmonary outflow tract and the other to replace the abnormal truncal valve. Two of these patients are doing well after 4 months. Another child survived the operation and did well for 2 months when she died suddenly. The last child died 14 hours postoperatively from low cardiac output syndrome secondary to diabetic hypertrophic cardiomyopathy. When truncal valvar abnormalities are present, the primary repair of truncus arteriosus in an infant should include replacement of the truncal valve. Total correction can be successfully achieved using two valved homografts, resulting in long-term palliation and freedom from thromboembolic events and the use of anticoagulants. 相似文献
13.
Y Naito K Fujiwara Y Takagaki S Kawasaki H Suzuki S Uemura 《[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai》1992,40(2):330-333
The prognosis of infants with truncus arteriosus associated with severe truncal valve insufficiency is quite poor. Total correction was successfully performed in a neonate with such a complicated anomaly. The patient was 21 days old female with anuria due to severe congestive heart failure preoperatively in spite of medical treatment. She underwent Rastelli operation and pulmonary artery was reconstructed using autologous pericardial 3 valved conduit. Truncal valve was 4 cusps with the malformed nodular margins and one cusp had cleft. This cleft was closed suturing the cleft cusp and adjacent cusp each other and annuloplasty was added in 4 commissures. She survived and her truncal valve insufficiency was still mild at 2 years post-operative period. Although total correction with truncal valve repair for such a severely ill neonate and young infant with truncus arteriosus as this patient has not been reported, our experience suggests that severe truncal valve insufficiency could be fairly well repaired by valvulo-annuloplasty. 相似文献
14.
T Tsukube M Yamaguchi Y Hosokawa H Ohashi M Imai Y Oshima 《[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai》1990,38(9):1543-1548
A 9-year-old boy had a successful surgical correction of truncal valve regurgitation and obstruction of extracardiac conduit which ensued previous Rastelli operation. He underwent Rastelli operation at the age of 10 months with the diagnosis of truncus arteriosus (Collet & Edwards Type I). At the age of 8 years, he was admitted because of slow weight gain and cardiomegaly (CTR 64%). Cardiac catheterization showed elevated RV pressure, increased pressure gradient across the conduit and severe truncal valve regurgitation. The extracardiac conduit was replaced with a 22 mm Hancock valved conduit and the truncal valve with 23 mm St. Jude Medical aortic valve. Postoperative catheterization revealed a normal RV pressure, only slight pressure gradient across the conduit and no truncal valve regurgitation. He is doing quite well 2 years after the operation. 相似文献
15.
Thompson LD McElhinney DB Reddy M Petrossian E Silverman NH Hanley FL 《The Annals of thoracic surgery》2001,72(2):391-395
BACKGROUND: Repair of truncus arteriosus in the neonatal and early infant periods has become standard practice at many centers. We reviewed our recent experience with repair of truncus arteriosus in neonates, with a focus on early and intermediate outcomes. METHODS: From July 1992 to December 1999, 65 patients 1 month of age or less underwent primary complete repair of truncus arteriosus. Median age was 10 days, and median weight was 3.2 kg. Major associated anomalies included moderate or severe truncal valve regurgitation in 15 patients (23%), interrupted aortic arch in 8 (12%), coronary artery abnormalities in 12 (18%), and nonconfluence of the pulmonary arteries in 3 (5%). Median durations of cardiopulmonary bypass and cardioplegic arrest were 172 minutes and 90 minutes, respectively. Circulatory arrest was employed only in 7 patients undergoing concomitant repair of interrupted arch. Reconstruction of the right ventricular outflow tract was achieved with an aortic (n = 39) or pulmonary (n = 26) allograft valved conduit (median diameter, 12 mm). Replacement (n = 6) or repair (n = 5) of a regurgitant truncal valve was performed in 11 patients, and interrupted arch was repaired in 8. RESULTS: There were three early deaths (5%). Early reoperations included reexploration for bleeding in 3 patients, emergent replacement of a pulmonary outflow conduit that failed acutely in 1 patient, and placement of a permanent pacemaker in 1. Mechanical circulatory support was required in 1 patient. During the median follow-up of 32 months, there were two deaths. The Kaplan-Meier estimate of survival was 92% at 1 year and beyond. The only demographic, diagnostic, or operative factors significantly associated with poorer survival over time were operative weight of 2.5 kg or less (p = 0.01) and truncal valve replacement (p = 0.009). Actuarial freedom from conduit replacement among early survivors was 57% at 3 years. CONCLUSIONS: Repair of truncus arteriosus in the neonatal period can be performed routinely with excellent survival, even in patients with major associated abnormalities. 相似文献
16.
R M Di Donato D A Fyfe F J Puga G K Danielson D G Ritter W D Edwards D C McGoon 《The Journal of thoracic and cardiovascular surgery》1985,89(3):414-422
From 1965 until March, 1982, 167 patients underwent surgical repair of truncus arteriosus. The age at operation ranged from 18 days to 33 years (mean 6 years). There were 48 hospital deaths (28.7%). The following factors had a positive correlation with the possibility of a surgical death: age at operation less than 2 years (p less than 0.001), a postrepair pulmonary arterial/left ventricular pressure ratio greater than 0.5 for patients with two pulmonary arteries (p less than 0.001) and greater than 0.6 for patients with unilateral absence of a pulmonary artery (p less than 0.02), and a postrepair right ventricular/left ventricular pressure ratio greater than 0.8 (p less than 0.008). The 119 hospital survivors were followed up for a total of 829 person-years. Late survival rate at 5 years was 84.4% and at 10 years, 68.8%. Preoperative factors that correlated with a reduced long-term survival rate were as follows: increasing age at operation (p = 0.004), the presence of moderate or severe truncal valve insufficiency (p = 0.008), lower pulmonary/systemic flow ratio (p = 0.04), and unilateral absence of a pulmonary artery (p less than 0.001). Thirty-six patients required reoperation during the follow-up period (30%) primarily for replacement of the right ventricular-pulmonary arterial conduit and/or for truncal valve replacement. The long-term results obtained in these patients support the need for early repair of the anomaly, improvement in the methods for control or repair of the truncal valve insufficiency, and the continued search for better extracardiac valved conduits. 相似文献
17.
E L Bove R H Beekman A R Snider L B Callow D J Underhill A P Rocchini M Dick A Rosenthal 《The Annals of thoracic surgery》1989,47(4):499-505; discussion 506
Infants with truncus arteriosus present a difficult management issue. Because of the high operative mortality, repair is often delayed beyond the first 3 to 6 months of age. We reviewed our experience with 11 neonates and young infants with truncus arteriosus undergoing repair (median age, 21 days). Five patients also had major truncal valve insufficiency, and 2 required valve replacement. Right ventricle-pulmonary artery continuity was established with a porcine valved conduit in 3 patients and an aortic or pulmonary homograft in 8. There was 1 operative death (9%; 70% confidence limits, 3%-22%) and 1 late death over a mean follow-up of 21 months (range, 4 to 32 months). Eight of the 9 late survivors are growing normally. Echocardiographic examination revealed normal ventricular function in all patients (mean shortening fraction, 39%). Doppler assessment demonstrated trivial prosthetic or homograft valve regurgitation in 7 patients and mild to moderate obstruction in 5 patients. This recent experience with repair of truncus arteriosus indicates that the operative risk is low even in the neonate. Repair in the first month of life should be recommended before the development of critical congestive heart failure or irreversible pulmonary vascular disease. 相似文献
18.
Schlichter AJ Kreutzer C Mayorquim RC Simon JL Román MI Vazquez H Kreutzer EA Kreutzer GO Jonas SR 《The Journal of thoracic and cardiovascular surgery》2000,119(5):869-879
OBJECTIVE: Evaluate long-term results of autologous pericardial valved conduits in the pulmonary outflow. METHODS: Between June 1983 and October 1993, 82 conduits were placed in the outflow of the venous ventricle. Patients who received homografts (n = 2 patients), heterografts (n = 3 patients), and valveless conduits (n = 19 patients) and those patients who died within 90 days after the operation were excluded. Fifty-four survivors of pulmonary outflow reconstruction with fresh autologous pericardial valved conduits were followed up from 5 to 15 years (mean, 7.47 +/- 2.8 years). Diagnosis include d -transposition of great arteries (n = 16 patients), L -transposition of great arteries (n = 14 patients), tetralogy of Fallot, pulmonary atresia with ventricular septal defect (n = 11 patients), truncus arteriosus (n = 10 patients), and double-outlet ventricle (n = 3 patients). Implantation age ranged from 0.25 to 24 years (mean, 5.2 +/- 4.2 years). Median conduit diameter was 16 mm. Two-dimensional echocardiographic Doppler evaluations were made yearly; 9 patients underwent cardiac catheterization. Reintervention for stenosis was indicated when the pressure gradient exceeded 50 mm Hg. RESULTS: Three late deaths were unrelated to the conduit. Thirty-five autologous pericardial valved conduits increased in diameter (1-7 mm), remained unchanged in 15 patients, and reduced 1 to 2 mm in 4 patients. The median diameter was 18 mm at the last evaluation (P =.0001). Eight patients required conduit-related reoperation 3 to 8 years after the implantation. Two patients underwent balloon dilation of the autologous pericardial valved conduit. No conduit had to be replaced. Freedom from reintervention at 5 and 10 years was 92% and 76%, being 100% at 10 years for conduits larger than 16 mm at time of implantation. CONCLUSIONS: Autologous pericardial valved conduits show excellent long-term results and compare favorably with other conduits. 相似文献
19.
Tomas Tlaskal Bohumil Hucin Vladimir Kucera Pavel Vojtovic Roman Gebauer Vaclav Chaloupecky Jan Skovranek 《European journal of cardio-thoracic surgery》2005,28(5):736-741
OBJECTIVE: The aim of our study was to analyse experience with repair of truncus arteriosus with interrupted aortic arch. METHODS: Between 1993 and 2004, eight consecutive patients underwent repair of truncus arteriosus with interrupted aortic arch. The median age was 6.5 days (range 1-85 days) and median weight was 3.2 kg (range 2.6-4.8 kg). Five patients had type A and 3 patients had type B aortic arch interruption. The repair was performed in deep hypothermia with circulatory arrest in 4 patients and isolated selective low-flow perfusion of the head and the heart in the last 4 patients. The repair consisted in aortic arch reconstruction by direct anastomosis between descending and ascending aorta, closure of ventricular septal defect and reconstruction of the right ventricular to pulmonary artery continuity using a valved conduit. RESULTS: One (12.5%) patient died from sepsis and hepato-renal failure 18 days after surgery. Seven (87.5%) patients were followed up for 2.0-11.7 years (median 2.6 years). No patient died after the discharge from hospital. In 4 patients 1-3 reinterventions were required 0.6-10.0 years after repair. Reoperations were performed for conduit obstruction in 2 patients, aortic regurgitation in 2 patients, right pulmonary artery stenosis in 2 patients and airway obstruction in 1 patient. In 2 patients concommitant aortic valve and conduit replacement was required. Balloon angioplasty for aortic arch obstruction was necessary in 1 patient, and for bilateral pulmonary branch stenosis in 1 patient. Five (28.6%) surviving patients are in NYHA class I and 2 (71.4%) patients are in NYHA class II. CONCLUSIONS: Primary repair of persistent truncus arteriosus with interrupted aortic arch can be done with low mortality and good mid-term results. Aortic arch reconstruction in isolated low-flow perfusion of the head and the heart influences favourably the postoperative recovery. The main postoperative problems are associated with conduit obstruction and aortic insufficiency. 相似文献
20.
Abstract Objective: This study aims to analyze long‐term results after correction of type I and type II truncus arteriosus in older patients operated in one institution over five years. Methods: Between 2006 and 2010, 12 patients, median age 4 years, underwent repair of truncus arteriosus. Repair with reconstruction of the right ventricular to pulmonary artery continuity was performed using a valved conduit in 12 patients. Results: There was no early mortality. All patients are alive with their original conduit 0.6 to 5 years after correction. No patients required reoperations for conduit dysfunction. Recent clinical examination was undertaken in all patients and they are in good condition. Conclusions: Though mean age at operation was higher in this study than published results, the operation should be performed if the pulmonary vascular resistance is under 8 units.m2 before operation . 相似文献