成人法乐氏四联症的外科治疗

１９８７年１月至１９９５年６月施行成人法乐氏四联症根治术４３例。全组病人均有右室流出道狭窄，３４例伴肺动脉瓣狭窄，２例肺动脉瓣、瓣环和肺动脉多处狭窄。室间隔缺损用涤纶片修补，先在缺损后下缘置３针褥式缝线，其余边缘用４—０Ｐｒｏｌｅｎｅ带针线连续缝合。为避免术后右室流出道狭窄，宜选用涤伦片和自体心包组成的复合片加宽右室切口，本组术后死亡２例，死亡率４．６％。成人法乐氏四联症根治术可获与儿童病例相同的手术效果     

法乐氏四联症患者围手术期护理

随着心脏外科的飞速发展,心脏手术成功率日益提高,法乐氏四联症病情重危,手术复杂、术后病情变化快。法乐氏四联症患者围手术期的护理要点如下。一、法乐氏四联症的病理生理:法乐氏四联症包括心室间隔缺损,肺动脉狭窄、主动脉骑跨、右心室肥大四种病理改变,其主要病理生理变化是肺循环血运不足致血氧降     

室间隔缺损残余漏的防治

目的 探讨26（7．01％）倒室间隔缺损（VSD）修补术后残余漏的发生原因及防治方法。方法 回顾374例室间隔缺损（VSD）修补术后出现26例残余漏进行分析。结果 分析认为造成残余漏除技术原因外，还与修补的方法有关，随访21年至今，Echo示自行闭合4例，缩小6例，二次手术修补VSD 1例，无死亡。结论 提高修补技术及选择适当的修补方法，是避免残余漏的发生及防治的关键。     

室间隔缺损修补术后残余漏的外科治疗

目的　总结室间隔缺损 (室缺 )修补术后残余漏的外科治疗经验 ,探讨残余漏的易发部位。方法　 1979年 1月至 2 0 0 3年 5月对 37例室间隔缺损术后残余漏患者行手术治疗 ,单纯室间隔缺损术后残余漏 19例、法洛四联症术后室间隔残余漏 17例、右心室双出口术后室间隔残余漏 1例 ,占同期心脏手术的 0 2 1% (37/ 180 0 0 )。其中男 2 6例、女 11例 ,年龄 3个月～ 5 3岁 ,平均 (16± 12 )岁。全组以室缺术后再度出现心脏杂音并行超声心动图检查确诊。手术用补片修补残余漏 2 6例 ,直接缝合残余漏 11例。结果　手术死亡 2例 ,病死率 5 % (2 / 37) ;手术成功 35例 ,术后随访 3个月～ 15年 ,疗效满意。结论　室间隔缺损修补术后残余漏多见于三尖瓣隔瓣根部 ,其次为第二和第一转移针处 ;室间隔缺损残余漏二次手术效果良好。     

室间隔缺损残余漏的防治与转归

探讨７２１例室间隔缺损修补术后２８例（３．８％）残余漏的发生原因和转归，提出正确的防治方案。分析认为造成残余漏的主要原因是手术技术问题。对残余缺损＜０．５ｃｍ无症状者，可暂不手术；＞０．５ｃｍ有症状者，应及时再手术。本组二次手术修补３例，自行闭合４例，缩小１７例，无变化１例，变大１例，死亡２例。作者提出，提高修补技术和掌握适当再手术时机是残余漏预防和治疗的关键。     

大型室间隔缺损伴肺动脉高压的外科治疗

目的 总结59例大型室间隔缺损(VSD)伴肺动脉高压在心脏不停跳下行VSD修补术的经验. 方法 59例大型VSD伴肺动脉高压患者均在浅低温心脏不停跳下行VSD修补术. 结果手术死亡1例,其余患者术后无低心排血量综合征、严重心律失常,发现残余漏4例和Ⅲ°房室传导阻滞2例,均治愈出院.术后随访未发现残余漏,无其他并发症和晚期死亡. 结论在心脏不停跳下行大型VSD修补术,能更好地保护心肺功能,术中能避免残余漏和Ⅲ°房室传导阻滞的发生,临床效果良好.     

法乐氏四联症术时年龄对远期预后的影响

法乐氏四联症术时年龄对远期预后的影响林娜，王善伯，蒲英英，赵淑琴，周微微法乐氏四联症完全矫治术的手术年龄与预后关系密切。材料与方法随访１９８１～１９９１年期间在我院行法乐氏四联症完全矫治术的病人６３例。其中男４７例，女１６例。术后１年内者１２例，３年...     

15例体外循环下心脏直视手术病人的护理

<正> 体外循环下心脏直视手术多用于房间隔缺损、室间隔缺损、法乐氏四联症等先天性心脏病及后天性心脏病的手术治疗。术前术后对病人心身实施整体护理并与医生密切配合,可收到良好的治疗效果。     

1例室间隔缺损残余漏患儿的护理

先天性心脏病室间隔缺损修补术患者,可因缺损修补不完善,修补缝线处撕破或心内感染等原因术后并发残余漏,病情险恶。我所1988年12月遇1例室间隔缺损修补术后并发残余漏患儿,经及时诊治和精心护理而获治愈,现报告如下:一、病例简介     

小儿法乐氏四联症的外科手术治疗

目的:分析探讨小儿法乐氏四联症的临床特点及手术治疗体会.方法:对46例4～46个月的法乐氏四联症患儿,在全麻低温体外循环下行法乐氏四联症根治术.结果:1例死亡.术后低心排者2例,灌注肺2例,肺炎、肺不张3例,胸腔积液1例,心包填塞二次开胸止血1例.结论:小儿儿法乐氏四联症外科治疗有其特殊性,术中操作应准确轻柔,疏通右室流出道切除隔束、壁束不宜广泛,室缺及右室流出道补片大小应适合.术后正确补充血容量,加强心功能支持.肺动脉发育情况及左心功能是影响手术疗效的最主要因素.     

Complete atrioventricular canal associated with tetralogy of Fallot or double-outlet right ventricle and right ventricular outflow tract obstruction: a report of successful surgical treatment

Six patients, 4 of whom had complete atrioventricular (AV) canal and tetralogy of Fallot (TOF) and 2 of whom had double-outlet right ventricle with subaortic ventricular septal defect (VSD) and right ventricular outflow tract obstruction, were treated. Two of the patients with complete AV canal and TOF had a shunt procedure only. The other 4 patients underwent complete repair. All 6 patients survived the operation. Complete repair was performed through the right atrium using the two-patch technique. The size and shape of the VSD patch is important. Residual VSD after repair was common. Two patients have undergone successful reoperation for this problem. Another patient has a small residual VSD.     

The results of probe technique for transatrial repair of tetralogy of Fallot

OBJECTIVE: Total correction of classic tetralogy of Fallot (TOF) by transatrial approach has become a standard procedure with a principal theoretical aim of minimizing structural damage to the pulmonary pump. The most critical point in transatrial repair of TOF is infundibular dissection. Right atrial approach provides better surgical exposure for parietal extension of the infundibular septum when compared to a right ventricular approach. However, it is not always easy to determine the localization and amount of muscle bundles to be resected and this surgical maneuver requires experience. METHODS: Nineteen patients were reviewed who had repair of isolated TOF by this technique from 1993 to 2001. The mean age of patients was 5 +/- 2 years. Transatrial-transpulmonary approach was performed for all patients. To make the infundibular muscle-bundle resection easier and to determine the localization and amount of muscle bundle to be resected, we placed a Hegar dilator into the right ventricle through pulmonary arteriotomy. The muscle bundles between the dilator and the anterior leaflet annulus of the tricuspid valve were totally excised until the intraventricular part of the dilator and pulmonary annulus became completely visible. The area between the Hegar dilator and the margins of the ventricular septal defect (VSD) was left untouched. None of the patients had transannular patch. Tricuspid valve detachment in order to improve the exposure was done in 11 patients. All patients were followed up in our clinic at regular six-month intervals by echocardiography. RESULTS: There was no early or late mortality nor reoperation for residual VSD or residual right ventricle (RV) outflow obstruction. All patients were in NYHA class I. RV on the echocardiography was spared late dilatation and had a good late functional status. Eighteen patients had no or mild pulmonary regurgitation. One patient who had undergone tricuspid anterior leaflet detachment showed mild tricuspid insufficiency. CONCLUSIONS: On the basis of hemodynamic outcomes, this procedure for elective repair of TOF in selected cases gives excellent early and mid-term results.     

Results of the probe technique for transatrial repair of tetralogy of Fallot

OBJECTIVE: Total correction of classical tetralogy of Fallot (TOF) by transatrial approach has become a standard procedure in the goal to minimize structural damage to the pulmonary pump. The most critical point in transatrial repair of TOF is infundibular dissection. Right atrial approach provides better surgical exposure for parietal extension of the infundibular septum when compared to the right ventricular approach. However it is not always easy to determine the localization and amount of muscle bundles to be resected and this surgical maneuver requires experience. METHODS: Nineteen patients who had repair of isolated TOF using this technique from 1993 to 2001 were reviewed. The mean age of patients were 5 +/- 2 years. Transatrial-transpulmonary approach were performed for all patients. To make easier the infundibular muscle bundles resection and to determine the localization and amount of muscle bundle to be resected, we placed a Hegar dilator into the right ventricle through pulmonary arteriotomy. The muscle bundles between the dilator and the anterior leaflet annulus of the tricuspid valve were totally excised until the intraventricular part of the dilator and pulmonary annulus became completely visible. The area between the Hegar dilator and the margins of the ventricular septal defect (VSD) was left untouched. None of the patients had transannular patch. To improve exposure, tricuspid valve detachment was performed in 11 patients. All patients were followed-up in our clinic every 6 months using echocardiography. RESULTS: There were no early or late deaths, and no reoperation for residual VSD or residual right ventricle (RV) outflow obstruction. All patients were in NYHA Class I. RV on the echocardiography was spared late dilatation and had a good late functional status. Eighteen patients had no or mild pulmonary regurgitation. One patient who had undergone tricuspid anterior leaflet detachment showed mild tricuspid insufficiency. CONCLUSION: On the basis of hemodynamic outcomes, this procedure for elective repair of TOF in selected cases shows excellent early and mid-term results.     

Does direct visualization of peripatch areas in beating heart eliminate the risk of residual ventricular septal defect in adult patients?

AIM: Although the incidence of residual ventricular septal defect (VSD) following surgical therapy in the modern series is very low, especially the risk of hemodynamically insignificant shunt still exists. Intraoperative assessment of residual shunt is useful in identifying patients at risk of having subsequently required reoperation and reintervention for residual VSD before chest closure. METHODS: In 87 patients who were operated because of isolated VSD (Group I), VSD was closed under cardioplegic arrest and right atriotomy or right ventriculotomy were closed in the beating heart after aortic cross-clamp removal. The VSD patch was watched out for residual shunt and additional sutures were placed if it existed. Results of this technique have been compared with the other 216 (Group II) in which all procedures of the VSD closure were performed under cardioplegic arrest. Transosephageal echocardiography (TEE) was performed for evidence of residual shunting intraoperatively and postoperatively in all patients. RESULTS: In group I, additional sutures were placed for residual shunt in 14 patients (16.1%), and insignificant residual shunt was detected in only one (1.1%) patient at early postoperative period (p<0.05, according to group II). In group II, there was hemodynamically insignificant residual shunt in 31 patients (14.5%), and 9 patients (4.2%) were reoperated for significant shunt (p<0.05). CONCLUSION: Transatrial or transventricular inspection to peripatch areas in the beating heart is a safe technique to detect a residual shunt, an observation that may eliminate reoperation.     

Results of the Probe Technique for Transatrial Repair of Tetralogy of Fallot

Abstract Objective: Total correction of classical tetralogy of Fallot (TOF) by transatrial approach has become a standard procedure in the goal to minimize structural damage to the pulmonary pump. The most critical point in transatrial repair of TOF is infundibular dissection. Right atrial approach provides better surgical exposure for parietal extension of the infundibular septum when compared to the right ventricular approach. However it is not always easy to determine the localization and amount of muscle bundles to be resected and this surgical maneuver requires experience. Methods: Nineteen patients who had repair of isolated TOF using this technique from 1993 to 2001 were reviewed. The mean age of patients were 5 ± 2 years. Transatrial‐transpulmonary approach were performed for all patients. To make easier the infundibular muscle bundles resection and to determine the localization and amount of muscle bundle to be resected, we placed a Hegar dilator into the right ventricle through pulmonary arteriotomy. The muscle bundles between the dilator and the anterior leaflet annulus of the tricuspid valve were totally excised until the intraventricular part of the dilator and pulmonary annulus became completely visible. The area between the Hegar dilator and the margins of the ventricular septal defect (VSD) was left untouched. None of the patients had transannular patch. To improve exposure, tricuspid valve detachment was performed in 11 patients. All patients were followed‐up in our clinic every 6 months using echocardiography. Results: There were no early or late deaths, and no reoperation for residual VSD or residual right ventricle (RV) outflow obstruction. All patients were in NYHA Class I. RV on the echocardiography was spared late dilatation and had a good late functional status. Eighteen patients had no or mild pulmonary regurgitation. One patient who had undergone tricuspid anterior leaflet detachment showed mild tricuspid insufficiency. Conclusion: On the basis of hemodynamic outcomes, this procedure for elective repair of TOF in selected cases shows excellent early and mid‐term results.     

Outcome after one-stage repair of tetralogy of Fallot

AIM: The purpose of this study was to evaluate the outcome after one-stage repair of tetralogy of Fallot (TOF). METHODS: Between May 1997 and December 2002, 240 patients with a median age of 9 months (1 month-48 years) underwent one-stage repair of TOF. Closure of ventricular septal defect (VSD) was accomplished through the right atrium in 171 (71.3%) patients and through the right ventricle in 69 (28.7%) patients. For the reconstruction of the right ventricular outflow tract (RVOT), transannular repair was performed in 151 (62.9%) patients, and non-transannular repair was performed in 89 (37.1%) patients. Follow-up was complete, averaging 40+/-17.6 months (3 months-5.8 years). RESULTS: There were 2 (0.8%) operative deaths. Between early repair group (age under 6 months) and late repair group (age above 6 months), there were no differences in the method of RVOT reconstruction (transannular vs non-transannular) and the need for branch pulmonary artery angioplasty. Early repair group had more transventricular VSD closure than late repair group (46% vs 22%, P < 0.05). Duration of inotropic support and intensive care unit (ICU) stay were longer in the early repair group (P < 0.05). Five patients required reoperations due to RVOT obstruction (n = 3), and residual VSD (n = 2). Kaplan-Meier freedom from reoperation at 5 years was 98.3+/-1%. Nine patients underwent catheter intervention for branch pulmonary artery stenosis. Freedom from reintervention at 5 years was 95.4+/-1.5%. All survivors are currently asymptomatic. CONCLUSIONS: One-stage repair of TOF could be performed with low mortality and morbidity. Especially, early one-stage repair in symptomatic infant could be performed with low risk, eliminating the need for palliative procedures.     

A case of an elderly man who required repeated repair of a ventricular septal defect and tricuspid rupture after blunt chest trauma

Several cases of traumatic ventricular septal defect (VSD) have been reported. However, traumatic VSD complicated by tricuspid rupture is rare. We report a case of traumatic VSD with tricuspid rupture who required repeated repair of both conditions. A 69-year-old man was transferred to our hospital for emergent surgical repair of traumatic VSD and tricuspid rupture. Although emergent repair was performed, a new left-to-right shunt and moderate tricuspid regurgitation appeared during his postoperative course. A reoperation was performed 4 months after the first operation. The borders of the defect were very fibrotic and strong compared with those in the first operation. Surgical treatment of traumatic VSD should be postponed in hemodynamically stable patients. When emergent repair is performed, careful follow-up is necessary to diagnose new VSD.     

Early results after transatrial/transpulmonary repair of tetralogy of Fallot.

OBJECTIVES: Right ventricular (RV) dysfunction is a significant cause of morbidity and mortality after surgical correction of tetralogy of Fallot (TOF). Transatrial/transpulmonary repair avoids a ventriculotomy (in contrast to the transventricular approach) emphasizing maximal preservation of RV structure and function. We have adopted this technique as less traumatic for the right ventricle. This study evaluates the early surgical results of our approach. METHODS: Between September 1997 and July 2001, 110 consecutive patients with TOF were referred to our unit for surgical therapy. Of these, 14 were unsuitable for repair and underwent aortopulmonary shunting+/-pulmonary artery patching. In the remaining 96 patients (median age 1.4 years), complete transatrial/transpulmonary repair was performed. Previously placed shunts (ten patients) were taken down and any secondary stenoses or branch pulmonary artery distortion repaired. In all cases, subpulmonary resection and ventricular septal defect (VSD) closure were accomplished transatrially. Whenever pulmonary valvotomy and valve ring widening were necessary, it was achieved through a pulmonary arteriotomy. In 84 patients the main pulmonary artery was augmented with an autologous pericardial patch, and in 23 the patch was extended to pulmonary artery branch(es). A limited (<1cm ) or extended (>1cm, but 相似文献   

Intravascular hemolysis due to residual shunt after patch closure of VSD: a case report]

A patient with intravascular hemolysis due to residual shunt after patch closure of VSD was presented. The patient was 31-day-old female. She underwent VSD closure with Dacron patch 2 weeks after the initial operation (subclavian flap method) for coarctation concomitant with VSD. Soon after the operation, severe intravascular hemolysis and hemolytic anemia appeared. Conservative therapies were not effective, and her general condition got worse gradually. Forty days after closure of VSD, she underwent reoperation and the shunt was closed. Hemolysis disappeared dramatically. It was suggested that early reoperation was necessarily when severe intravascular hemolysis due to residual shunt after patch closure of VSD had persisted.     

心室双出口手术治疗临床研究

目的：探讨心室双出口的手术治疗效果。方法：回顾性分析72例心室双出口病人手术治疗方法及治疗效果。右室双出口71例中SDD型64例，ILL型3例，SDL型3例，IDD型1例；左室双出口1例（ILD型）。采用左心室-主动脉心内隧道连接61例，全腔静脉-肺动脉连接2例，左心室-主动脉心内隧道并右心室-肺动脉心外管道连接3例，Glenn分流6例。结果：死亡2例。1例术后3个月发现残余室间隔缺损，予再次手术缝合。余者效果良好，无远期死亡及相关并发症发生。结论：根据心室双出口的不同类型，选择最佳手术方式及掌握手术时机是成功的重要因素，重建通畅良好的左或右室流出道是提高手术成功率的关键因素。