右胸前外侧小切口房间隔缺损修复术

右胸前外侧小切口房间隔缺损修复术周凯＊张仁福朱洪玉赁常文张南滨汪曾炜房间隔缺损（ＡＳＤ）是常见先天性心脏畸形，经胸部正中切口修复创伤大，且术后切口疤痕增生明显。自１９９３年１２月～１９９６年１０月我们对６１例女性患者采取经右胸前外侧小切口行ＡＳＤ修复...     

经胸小切口封堵房间隔缺损手术效果观察

目的总结经胸小切口封堵房间隔缺损手术经验与疗效。方法2001年5月~2005年9月,我院采用非体外循环经胸小切口治疗房间隔缺损206例,房间隔缺损直径4.8~44.3 mm,其中>30 mm 100例,房间隔缺损伴膨出瘤2例。右侧第4肋间做2~3 cm小切口,显露右心房并在其外侧壁荷包缝合,将双腔推送导管穿刺入右心房,在食管超声引导下经房间隔缺损送入左心房,并释放直径比房间隔缺损最大径大4 mm的镍钛记忆合金封堵器,退出推送导管。结果206例均顺完成手术。手术时间18~32(26±7)m in。无手术死亡,无封堵器脱落。术后5 h拔除气管插管,患者当日即可下床活动。术后3 d复查彩色多普勒,无残余分流。术后住院(4±2)d。186例随访6个月,57例随访3~4.5年,病人恢复良好,彩色多普勒显示均无残余分流,心功能均正常。结论经胸小切口封堵方法治疗房间隔缺损安全可靠,适用于不能介入封堵的房间隔缺损治疗。     

右径小切口房间隔缺损封堵术21例临床分析

目的探讨右径小切口房间隔缺损封堵术的方法与疗效。方法回顾性分析我院2004年7月至2005年5月收治的21例房间隔缺损患者,男性8例,女性13例,年龄1～70岁,中位年龄21岁。房间隔缺损直径8～40mm。全麻下右胸骨旁第4肋间行2～3cm切口,在经食管或胸壁超声引导下,经右心房通过单鞘管置入房间隔缺损封堵器。结果全组21例无手术死亡,使用的封堵器型号为14～46mm,均封堵满意,无残余分流,未影响心脏瓣膜功能。无封堵失败改行体外循环手术者。术中未输血,术后未发生封堵器移位或脱落等严重并发症,术后3～5d出院。复查无残余分流,无严重并发症,效果满意。结论右径小切口封堵房间隔缺损安全、创伤小,有一定推广价值。     

经胸小切口房间隔缺损封堵术41例报告

目的探讨经胸小切口房间隔缺损封堵术治疗房间隔缺损（atrial septal defect,ASD）的疗效。方法胸骨右旁第4肋间切口长3～4 cm,切开心包并悬吊,于右心房壁缝双荷包线,并切开,将输送导管（国产）插入右心房内,通过房间隔缺损口入左心房,在经左胸壁或食道超声监视下,释放出房间隔封堵伞,调整左右侧伞盘夹紧封堵ASD,用保险绳做反复牵拉试验,确认封堵伞位置合适,再做一针贯穿右房壁和伞边缘的褥式缝合固定。结果39例成功封堵,手术时间45～95min,平均60 min;术后住院3～6 d。术后2～24个月复查,心脏彩超检查封堵伞无移位,无残余分流。2例封堵不成功术中转开胸体外循环下完成手术。结论在经胸壁超声监视下房间隔缺损封堵术是一种微创、安全、简便,值得推广的方法。     

微创小切口手术修补与介入封堵治疗单纯继发孔型房间隔缺损

目的比较微创小切口手术修补与介入封堵治疗房间隔缺损(atrial septal defect,ASD)的优缺点。方法回顾分析2004年1月～2006年6月采用微创方法治疗单纯继发孔型ASD69例资料,其中行小切口心脏不停跳下手术修补37例(小切口组),行介入封堵32例(介入组)。结果两组均无死亡病例。小切口组37例手术全部成功,手术时间(145.86±27.84)min,体外循环时间(35.11±8.45)min,住院时间(15.46±3.09)d,发生主要并发症2例、次要并发症6例,住院费用(2.19±0.36)万元。介入组2例封堵失败,余30例成功,手术时间(88.59±7.75)min,住院时间(10.81±5.02)d,发生主要并发症1例、次要并发症2例,住院费用(2.78±0.39)万元。小切口组随访3～12个月20例、12～30个月17例,介入组随访3～12个月16例、12～30个月14例,均无残余分流。结论两种微创方法均可安全有效地用于单纯继发孔型ASD的治疗,微创小切口方法的费用低,成功率高,适应证广,而介入封堵方法的住院时间短,创伤更小,美容效果更好。     

成人房间隔缺损的手术治疗

成人房间隔缺损的手术治疗杨国泰张杰春许志方我院自１９７４年１月～１９９３年１１月在体外循环下手术治疗２０岁以上成人房间隔缺损患者８９例，占同期房缺手术患者（８９／３９７）的２２．０４％，手术疗效好，无手术死亡，现报道如下。１临床资料男２３例，女６６例...     

2例微创经胸非体外循环房间隔缺损封堵术患者的护理

对2例房间隔缺损患者采用微创经胸壁小切口非体外循环封堵术。结果手术均获成功，手术时间30、60min，术中出血量50ml，术后4、5d痊愈出院。术后1个月随访，经X线摄片、心电图等检查未见封堵器脱落、变形及残余血液分流，心功能良好。提出术前加强心理护理和术前准备，术后严密观察生命体征变化，保持呼吸道通畅，积极进行对症治疗和预防并发症的发生是使患者早日康复的重要措施。     

微创右胸小切口修补房间隔缺损(附31例报告)

报告自1997年5月至1998年11月期间采用微创右胸小切口修补房间隔缺损31例的结果。原发孔房间隔缺损合并二尖瓣大瓣裂缺1例,继发孔房间隔缺损30例,其中,中央型缺损25例,上腔型缺损1例,下腔型缺损2例,合并室间隔缺损2例,合并右肺静脉异位引流2例。手术通过右胸第四肋间小切口(7～10cm)在体外循环下完成,全组无手术死亡和并发症,病人恢复快。结论:右胸小切口修补房间隔缺损是可行的,并且比传统切口具有更多的优点     

2例微创经胸非体外循环房间隔缺损封堵术患者的护理

对2例房间隔缺损患者采用微创经胸壁小切口非体外循环封堵术.结果手术均获成功,手术时间30、60 min,术中出血量50 ml,术后4、5 d痊愈出院.术后1个月随访,经X线摄片、心电图等检查未见封堵器脱落、变形及残余血液分流,心功能良好.提出术前加强心理护理和术前准备,术后严密观察生命体征变化,保持呼吸道通畅,积极进行对症治疗和预防并发症的发生是使患者早日康复的重要措施.     

复合技术治疗低龄低体重病儿房间隔缺损

目的 介绍一种房间隔缺损(ASD)"复合"技术介入封堵方法,并探讨该手术方法的优缺点.方法 2007年6月至2008年3月,27例婴幼儿房间隔缺损者接受新"复合"技术治疗.其中男15例,女12例.年龄3个月-4岁,平均(2.00±O.22)岁.采用浅镇静加局部麻醉,非气管插管单纯面罩吸氧或喉罩下辅助通气支持,胸骨旁第4肋间小切口,保留胸膜,经胸膜外进入心包腔显露右心房壁,切开右房壁置入ASD封堵器及输送器.心前区或剑突下超声引导进行ASD介入封堵术.结果 全部病儿3d后康复出院,随访0.5-9.5个月,平均(5.9±0.5)个月,仅l例病儿因心包压塞行心包穿刺引流术,余无异常.超声检查没有残余分流或其它并发症.结论 该手术方法创伤小、疗效好,费用低,是婴幼儿ASD病例一种较为理想手术方法.     

膜周部室间隔缺损的微创封堵术

目的 探讨经胸壁微创室间隔缺损(VSD)封堵术对膜周部室间隔缺损(PVSD)的治疗效果及安全性.方法 2011年1月至12月,治疗129例PVSD患者(儿),男60例,女69例;年龄9个月～57岁.PVSD直径1.4～9.0 mm,均经胸骨中下1/3段3～5 cm正中小切口行微创VSD封堵术.术后密切随访观察,定期复查超声心动图和心电图.结果 114例封堵成功,15例术中转体外循环下行VSD修补术.其中应用等边封堵伞96枚,偏心封堵伞20枚.术后随访期间均无严重并发症发生.结论 经胸壁微创VSD封堵术治疗PVSD的近期治疗效果满意,具有良好的应用前景.目前尚缺乏长期的随访资料,有待进一步的随访观察.     

Intraoperative device closure of large secundum atrial septal defects; a safe alternative to transcatheter closure

OBJECTIVE: The aim of this study is to report our short and mid-term results of intraoperative device closure (IODC) in large secundum atrial septal defects (ASD), to evaluate its safety and to determine the impact of 'short' rim on the results. METHODS: Sixty-eight patients with an ASD underwent IODC through a right minithoracotomy. Patients were divided into two groups: 37 patients in group I with one short rim (< or =5 mm) and 31 in group II with sufficient rims. A 2.5-3 cm parasternal incision was made in the right third or fourth intercostal space. A specially designed plastic sheath loaded with the device was inserted through the purse-string sutures placed on the right atrium. Under transesophageal echocardiographic guidance, it was advanced through the ASD into the left atrium and the device was deployed in place. RESULTS: The procedure was successful in all patients. The maximum diameter of the ASD ranged from 20 to 37 mm (mean 25+/-5 mm). There were 16 patients with the diameter of ASD more than 30 mm. The mean size of implanted devices was 29+/-4mm. Redeployment with larger device occurred in seven patients in group I and three in group II (p>0.05). Intracardiac manipulation time was 22+/-10 min in group I and 16+/-11 min in group II (p<0.01). The total occlusion rate was 84% immediately after operation, 97% at 3 months, 98% at 1 year, and 100% at 2-, 3-, 4-year follow-up. There were no other late complications during the follow-up period of 3-63 months (mean 27+/-18 months). CONCLUSIONS: IODC is a safe and feasible technique in closing large ASDs. It has the advantages of cost savings, cosmetic results, and less trauma. Early and mid-term results are encouraging. In patients with ASD of a short rim, a larger device is recommended which does not influence the success rate of IODC.     

Results of surgical closure of isolated secundum atrial septal defect

Methods A retrospective analysis of all patients undergoing surgical closure of an isolated secundum atrial septal defect, at the Postgraduate Institute, Chandigarh between January 1974 and June 2000 was performed. 740 patients were divided into two groups. Group I. Included 435 patients under 20 yrs of age (223 male), 315 (72%) were asymptomatic, 265(61%) were in sinus rhythm. Group II. included 305 patients between 21 and 53 years (96 males), 27 patients (9%) were asymptomatic, 102(33%) were in sinus rhythm. Cardiopulmonary bypass with fibrillatory arrest and/or cold blood cardioplegia were used. In group I 291 patients (67%0 and in group II 64 patients (54%) underwent direct closure of the defect. In the remaining a patch was used for closure. Results There was 1 early death in group I (0.2%) and four in group II (1.3%) 96% of symptomatic patients in group I and 87% of patients in group II were improved. There were no instances of residual shunt. Follow up ranged from 6 months to 25 years (mean 8.3 yrs) and was 89% complete. Conclusions Closure of isolated secundum ASD is best performed before the patient attains adulthood.     

Amorphous cardiac tumor of right atrium late after atrial septal defect closure

We describe an unusual case of calcified cardiac mass in a patient seventeen years after Dacron patch closure of atrial septal defect. Presenting symptom was prolonged fever and after surgical excision the patient remains afebrile at one year of follow up. The clinical course and histopathological features were consistent with cardiac calcified amorphous tumor (cardiac CAT) Amorphous cardiac tumors are rare non-neoplastic cardiac masses, which are often indistinguishable clinically from true neoplasms. The surgical excision of these tumors is curative and recurrence is unknown.     

全胸腔镜房间隔室间隔缺损修补手术学习曲线

目的 总结全胸腔镜下心脏手术的学习曲线.方法 回顾性收集2004年10月至2010年1月由同一术者连续完成的125例全胸腔镜下房间隔缺损、室间隔缺损修补手术病例资料,按手术先后顺序分为A、B、C、D、E5组,每组25例,从各组手术时间、体外循环时间、主动脉阻断时间、中转开胸率及手术并发症等指标比较手术效果.结果 各组病例年龄、性别、体重、病种及手术方式差异无统计学意义(P＞0.05).手术时间、体外循环时间、主动脉阻断时间3项指标A、B组明显长于C、D、E组(P＜0.05),A、B两组间差异无统计学意义(P＞0.05),C、D、E3组之间差异亦无统计学意义(P＞0.05).各组中转开胸率及手术并发症发生率比较差异均无统计学意义(P＞0.05).结论 全胸腔镜房间隔、室间隔缺损修补术的学习曲线约为50例.     

全机器人不开胸房间隔缺损修补术

目的总结“达芬奇S”（da Vinci S）全机器人下不开胸房间隔缺损（ASD）修补术临床经验。方法1月至2007年7月，使用da Vinci S全机器人系统，不开胸完成房间隔缺损修补15例中男3例，女12例；平均年龄为（38．5±7．8）岁。均为继发孔型房间隔缺损，缺损直径2．0cm～3．6cm，无右向左分流，肺动脉压轻到中度升高。全组肺功能良好，无胸膜炎病史。超声引导下股动静脉及右侧颈内静脉插管建立体外循环。于右侧胸壁做3个直径均为1cm的器械臂孔，分别插入机器人系统的内窥镜和机械臂；1个直径为2cm工作孔。机器人操控医师于操作台前、三维成像系统下遥控机器人进行手术。直接修补10例，心包补片修补5例。术中食管超声评估修补效果。结果全组手术均成功，无术中手术方式的转变。平均体外循环（109．5±12．6）min，主动脉阻断（41．2±11．7）min。术中及术后出血明显减少，术后第2d出监护室，术后恢复明显加快，无残余分流和恶性心律失常等并发症的发生。结论全机器人不开胸房间隔缺损修补手术效果确实、可靠，是微创心脏外科的发展方向。     

50岁以上房间隔缺损介入与外科治疗的对比研究

目的　探讨高龄继发孔房间隔缺损 (ASD)病人的最佳治疗方式。方法　收集 5年来 5 0岁以上继发孔ASD行常规外科手术修补 5 3例和同期经导管介入Amplatzer双盘封堵器堵闭ASD 4 2例的资料进行分析 ,两组病例均采用彩色多普勒超声心动图测量心尖四腔心的右室长径、肺动脉压、三尖瓣反流面积、左室舒张末内径 ,左室射血分数等进行对比。结果　外科手术组成功 5 2例 ,成功率 98 1% ,术后出现脑栓塞、心包积液等并发症 13例 ( 2 4 5 % ) ,死亡 1例 ( 1 9% )。导管介入组堵闭成功率 97 6 % ,仅 1例于术后第 4d封堵器脱落移位至肺动脉。两组术后超声心动图复查显示 ,右心室超负荷明显改善 ,右心腔缩小 ,肺动脉高压改善或消失 ;住院天数外科组为 ( 19 8± 12 2 3)d ;介入组 ( 5 0± 2 5 )d。结论　外科手术治疗ASD适应证范围较介入组宽 ,对合并心脏结构明显异常者 ,需行外科手术 ,方可矫正血流动力学异常。介入组术前病例选择非常重要 ,严格掌握适应证范围和尽可能准确地了解ASD的最大直径 ,恰当选择封堵器的大小极为重要 ,经筛选的高龄ASD病人应用经导管介入治疗成功率高、并发症少、疗效好 ,恢复得快。     

Migraine-like headaches associated with nickel allergy requiring removal of atrial septal defect closure device

There is a deficit of literature regarding the association between nickel allergy–induced symptoms and implanted devices. This report describes a case of nickel allergy causing debilitating migraine-like symptoms, failing to resolve with medical therapy, requiring surgical removal of the device and repair of the defect.