右胸前外侧与胸骨正中切口矫治先天性心脏病的临床对比研究

目的 :研究比较右胸前外侧切口和胸骨正中切口在临床上矫治先天性心脏病的优缺点。方法 :将术前超声心动图检查及手术确诊为单纯房间隔缺损或单纯室间隔缺损的患者共 15 1例 ,分成右胸前外侧切口和胸骨正中切口手术 2组 ,从术后呼吸机辅助呼吸时间、术后 2 4h引流量、体外循环时间、术后住院天数、并发症的发生率等方面进行统计分析比较。结果 :术后呼吸机辅助时间及术后住院时间 ,2组病人无明显差别 ;术后 2 4h引流量 ,右胸前外侧切口组较少 ;体外循环时间胸骨正中切口组较短 ;胸骨正中切口组切口感染发生率为 3 42 %、胸骨畸形发生率为 4 2 7% ,右胸前外侧切口组无切口感染和胸骨畸形。结论 :右胸前外侧切口可对经右房或房间沟入路完成的简单的心内直视手术 ,具有美容效果好、术后渗血少、切口感染发生率低、无胸骨畸形等突出优点。缩短住院时间不明显。是否能减少手术创伤 ,有待进一步研究     

先天性心脏病右腋下小切口心内直视术围术期护理

目的分析先天性心脏病右腋下小切口心内直视术的围术期护理。方法选择我院2012年1月~2015年1月收治的行右腋下小切口心内直视术治疗的先天性心脏病患儿50例,治疗期间全部患儿均给予科学有效的围手术期护理干预,观察其护理效果。结果所有患儿的手术均顺利实施,病情保持稳定,有效脱离呼吸机患儿出血量少、疼痛显著缓解,未出现肺部感染,切口愈合情况理想,患儿经检查后完全正常,无并发症出现。结论加强右腋下小切口心内直视术的围手术期护理,能有效提高手术治疗的成功率,降低术后并发症发生率,促进患者更好康复。     

先天性心脏病右腋下小切口心内直视术的围术期护理

目的对先天性心脏病右腋下小切口心内直视术的围术期护理措施进行分析。方法选取我院2014年1月~2015年1月收治的先天性心脏病患儿90例作为研究对象,将其随机分为对照组与观察组,各45例。所有患儿均行右腋下小切口心内直视术。对照组患儿行常规护理干预,观察组患儿行综合性护理干预。观察患儿的手术效果,对比两组患儿的胸液引流量、呼吸机辅助时间及住院时间。结果患儿均顺利完成手术治疗,切口愈合良好。观察组患儿的胸腔引流量明显少于对照组,且呼吸及辅助时间、住院时间均短于对照组,差异有统计学意义(P0.05)。结论对先天性心脏病右腋下小切口心内直视术患儿加强围术期护理干预,能够确保手术顺利开展,提高手术效果,值得临床推广与应用。     

微创右腋下直切口与胸骨正中切口在心内直视手术中的对比

目的:比较右腋下直切口与胸部正中切口两种手术路径,在心内直视手术治疗常见先天性心脏病(先心病)的临床结果。方法:回顾性分析2012年5月至2014年2月,常见简单先心病房间隔缺损、室间隔膜部缺损、部分性心内膜垫缺损行微创右腋下直切口心内直视手术33例,选取既往相同疾病行传统胸部正中切口41例。对比两组患者手术时间、体外循环时间、输血量、术后引流量、术后呼吸机使用时间、术后住院时间及预后并进行总结。结果:两组患者均无死亡、出血致二次手术等重大并发症,在体外循环时间、术后呼吸机使用时间上两组比较,差异无统计学意义(P>0.05),而在手术时间、输血量、术后引流量和术后住院时间方面微创右腋下直切口组均优于传统胸骨正中切口组,差异有统计学意义(P<0.05)。术后随访6个月,两组患者超声心动图(UCG)均未发现残余分流、心包积液等并发症,传统胸部正中切口组4例患者出现鸡胸畸形,而微创切口组均恢复良好。结论:在常见先心病心内直视手术治疗中,微创右腋下直切口安全美观,并不增加术后并发症的发生,在术后恢复上显著优于传统胸骨正中切口。     

微创切口在10Kg以下婴幼儿先天性心脏病中的应用研究

【摘要】 目的 研究在体外循环(CPB)下经右腋下小切口和胸骨正中切口矫治婴幼儿童先天性心脏病的两种术式效果。方法 本研究取2005年9月至2014年9月我科婴幼儿先天性心脏病共126例,平均年龄1.0±0.2岁,平均体重8.5±0.3kg,均为简单型先天性性脏病。分成右腋下小切口组和胸骨正中切口组。比较两组患者的手术时间、CPB时间、术中阻断时间、术后呼吸机辅助时间、住院天数、术后引流量,术后并发症等指标。结果 两组均取得满意临床效果,正中切口组无手术死亡,术后III度房室传导阻滞2例,2周内均恢复,肺不张1例,胸骨愈合不良1例;右腋下小切口组术后传导阻滞3例,均恢复,死亡3例;2均为肺不张致肺部严重感染并全身败血症患者,1例心脏畸形合并动脉导管未闭(PDA),术中未能正确处理PDA,术后患者低心排而死亡。右腋下小切口组的术后胸液量(50.64±10.81)ml明显小于胸骨正中切口组的术后胸液量(86.11±11.25)ml,有显著性差异(P<0.05)。手术时间、CPB时间、术中阻断时间、术后呼吸机辅助时间和住院天数两组之间无显著性差异(P>0.05)。结论 经右腋下小切口矫治先天性心脏畸形安全、有效,能有效地替代正中切口剖胸矫治简单的先天性心脏畸形。术前明确诊断为选择此种切口必要条件,但对非限制性室间隔缺损,合并动脉导管的复杂畸形选择此种切口要慎重。 【关键词】 右腋下小切口; 胸骨正中切口 心脏外科手术。     

倒"J"形胸骨下段小切口在小儿心内直视手术中的应用

目的探讨应用倒"J"形胸骨下段小切口行小儿心内直视手术的安全性和手术创伤情况.方法应用倒"J"形胸骨下段小切口,对小儿先天性心脏畸型患者行心内直视手术矫治.全组50例,年龄8个月至14岁.手术主要病种:ASD、VSD、VSD PDA、ASD PS、PS.与近年相同年龄组标准胸骨正中切口比较.结果①切口长度明显缩小.②小切口的上端未超过胸骨角,在某种程度上满足了患者的美容需求.③术后胸廓的稳定性较好,术后胸廓畸形的发生率和程度明显减轻.④应用小切口能较好完成房间隔缺损,膜部及干下型室间隔缺损,肺动脉瓣狭窄等手术;但部分心内手术结构的显露受到一定影响.结论只要手术适应证选择合适,应用倒"J"形胸骨下段小切口,并不影响手术安全性;可取得创伤小、术后胸廓畸形轻和较好的美容效果.     

胸骨下段小切口心内直视手术40例

目的介绍胸骨下段小切口心内直视手术体会。方法选择10岁以下房间隔缺损3例、室间隔缺损20例,纵劈胸骨上至第二肋间;10岁以上房间隔缺损5例、室间隔缺损3例、风湿性二尖瓣狭窄9例,纵劈胸骨上至第二肋间并向右侧横断。常规体外循环,胸正中小切口第三胸肋关节水平至剑突根部,完成心内直视手术。结果无手术死亡,平均主动脉阻断时间、体外循环时间、术后24h胸液量与对照组无明显差异。切口长度约为常规胸骨正中切口的60%。结论胸骨下段小切口可以顺利完成部分心内直视手术,美观且保留了胸廓的连续性,无胸骨前凸畸形。     

小切口心脏不停跳心内直视手术治疗先天性心脏病

目的总结小切口心脏不停跳心内直视手术治疗先天性心脏病的优点。方法2001年1月至2005年2月共完成小切口心脏不停跳心内直视手术76例,包括房间隔缺损48例、室间隔缺损22例、肺动脉狭窄4例、单心房2例。合并畸形包括二尖瓣关闭不全、三尖瓣关闭不全、部分肺静脉异位引流等。结果本组患者体外循环时间(43.1±12.4)min,术后机械通气时间(3.0±1.1)h,术后引流量(3.2±1.5)ml/kg,术后住院(7.2±1.1)d。全组无1例死亡。所有患者随访14～65个月,无并发症。结论小切口剖胸矫治先天性心脏病具有创伤小、不破坏胸廓的完整性、切口隐蔽美观、恢复快等优点。     

右胸外侧小切口与胸骨正中切口心内直视手术的对比研究

目的探讨右胸外侧小切口行心内直视手术的疗效及治疗体会。方法回顾分析1999年6月～2009年3月期间,常见先心病患者行经右胸外侧小切口手术97例,与同期行正中切口进行同类先心病手术129例的治疗效果进行比较研究,对比研究两组主动脉阻断时间、体外循环时间、术后胸液量、辅助呼吸时间、术后平均住院时间、鸡胸发生率及住院死亡率。结果两组均无住院死亡;主动脉阻断时间、体外循环时间右胸组与正中组比较差异无统计学意义(P0.05);右胸组与正中组比较:平均总胸腔引流量分别为(223.9±127.1)ml,(379.4±203.9)ml;辅助呼吸时间分别为(248.5±74.4)min,(293.1±122.3)min;术后平均住院时间分别为(7.7±1.2)d,(9.4±0.86)d;鸡胸发生率分别为0%,2.3%(3/129);右胸组均低于正中组(P0.05)。结论右胸外侧小切口可安全有效地用于部分心内直视手术,与正中切口手术相比,明显缩短术后气管插管及住院时间,切口隐蔽,美观效果好。     

右腋下及腋前外小切口心内直视手术(摘要)

右腋下及腋前外小切口心内直视手术（摘要）贾清仁姚建民卢宁成杞润牛建立赵向东李文张笑萌１临床资料自１９９５年３月至１９９７年５月，我院应用右腋下及腋前外胸部小切口进行心内直视手术１００例（男３８例，女６２例）；年龄２～５１岁，平均１５．５岁。心房间隔缺...     

右前胸小切口治疗先天性心脏病65例

目的总结应用右前胸小切口进行心内直视手术的治疗体会.方法1999年3月-2003年6月,我们采用右前胸小切口行心内直视下修补先天性房、室间隔缺损65例,其中房间隔缺损37例,室间隔缺损28例.结果所有患者无手术死亡及手术并发症.结论经右前胸小切口进行心内直视手术是一种安全可靠的微创手术,对一些简单的先天性心脏病有良好的手术和美容效果,但不适合比较复杂的心脏病手术.     

右心感染性心内膜炎的临床特点（附23例分析）

目的探讨右心系统感染性心内膜炎的临床特征。方法２３例右心感染性心内膜炎患,从病因、临床表现、辅助检查和预后等进行分析。结果右心感染性心内膜炎主要发生于先天性心脏病,其次为静脉药瘾;其突出临床特点为肺栓塞;超声心动图对诊断右心感染性心内膜炎有重要价值。结论右心感染性心内膜炎具有一定临床特征,其预后良好。     

Impact of pulmonary vascular resistances in heart transplantation for congenital heart disease

Congenital heart disease is one of the major diagnoses in pediatric heart transplantation recipients of all age groups. Assessment of pulmonary vascular resistance in these patients prior to transplantation is crucial to determine their candidacy, however, it is frequently inaccurate because of their abnormal anatomy and physiology. This problem places them at significant risk for pulmonary hypertension and right ventricular failure post transplantation. The pathophysiology of pulmonary vascular disease in children with congenital heart disease depends on their pulmonary blood flow patterns, systemic ventricle function, as well as semilunar valves and atrioventricular valves structure and function. In our review we analyze the pathophysiology of pulmonary vascular disease in children with congenital heart disease and end-stage heart failure, and outline the state of the art pre-transplantation medical and surgical management to achieve reverse remodeling of the pulmonary vasculature by using pulmonary vasodilators and mechanical circulatory support.     

经右腋下微创直切口体外循环下直视心脏手术治疗小儿先天性心脏病

目的总结经右腋下直切口行体外循环直视心脏手术的临床经验,探讨其适应证及技术要点。方法2008年6月至2011年1月我们共完成79例经右腋下直切口的sJ,JL体外循环心脏直视手术,患者年龄6个月至12岁,平均（7．4±3.3）岁,体重6．5-42．0（17．8±8．7）kg。其中房间隔缺损19例,同期行三尖瓣成形5例;室间隔缺损55例,其中合并动脉导管未闭2例;部分房室管畸形5例。所有手术均在全身麻醉、体外循环下进行（房间隔缺损修补在不停跳下进行）。患者取左侧卧位,切口位于右侧第3肋间腋中线与第5肋间腋前线之间,皮肤切VI长度3．5-6．0（4．7±1．3）12111,经第3或第4肋间进胸,切开并悬吊心包,行升主动脉及上、下腔静脉插管建立体外循环,经主动脉根部灌注心脏停搏液,单纯房间隔缺损采用心脏不停跳下手术,经右心房切口修补房、室缺及三尖瓣成形。结果全组手术均顺利完成,无手术死亡;1例因术后心内膜炎致室缺残余漏,再次正中开胸行室缺残余漏修补术。体外循环时间（63．4±18．2）min,主动脉阻断时间（37．6±14-3）min,术后24h胸腔引流40-130（85．3±26．5）ml。68例患者术后未输血。全组无其他严重并发症。结论右腋下小切口直视心脏手术安全、可靠,可减少用血量,术后切口隐蔽美观,患儿及家属满意率高,值得临床椎广。     

Indications for heart transplantation in congenital heart disease

In this review we have looked at indications for cardiac transplantation in congenital heart disease. An outline of the general principles of the use of transplant as a management strategy both as a first line treatment and following other surgical interventions is discussed. We explore the importance of the timing of patient referral and the evaluations undertaken, and how the results of these may vary between patients with congenital heart disease and patients with other causes of end-stage heart failure. The potential complications associated with patients with congenital heart disease need to be both anticipated and managed appropriately by an experienced team. Timing of transplantation in congenital heart disease is difficult to standardize as the group of patients is heterogeneous. We discuss the role and limitations of investigations such as BNP, 6 minute walk, metabolic exercise testing and self estimated physical functioning. We also discuss the suitability for listing. It is clear that congenital heart patients should not be considered to be at uniform high risk of death at transplant. Morbidity varies greatly in the congenital patient population with the failing Fontan circulation having a far higher risk than a failing Mustard circulation. However the underlying issue of imbalance between donor organ supply and demand needs to be addressed as transplant teams are finding themselves in the increasingly difficult situation of supporting growing numbers of patients with a diverse range of pathologies with declining numbers of donor organs.     

Minimally Invasive Congenital Cardiac Surgery: A Large Volume European Experience

Background: In an effort to reduce postoperative trauma and achieve more cosmetic results, minimally invasive approaches to correct congenital heart anomalies have been recently proposed and increasingly adopted. Here we describe our experience for the past 23 years. Methods: Patients who underwent a surgical procedure between February 1996 and March 2019 with a minimally invasive approach for the correction of congenital heart disease in our center were included in this study. A statistical analysis was carried out to compare the results of the different minimally invasive techniques. A meta-analysis was conducted to compare our results in patients undergoing atrial septal defect repair with those from other groups. Results: There were 1002 patients included. A midline lower mini-sternotomy was performed in 45% of patients (n = 455), a right anterior mini-thoracotomy in 36% (n = 356) and a right lateral minithoracotomy in 19% (n = 191). The procedures were atrial septal defect repair (n = 575, 57%), ventricular septal defect repair (n = 218, 22%), and correction of atrioventricular defect (n = 82, 8%) or partial anomalous pulmonary venous return (n = 70, 7%). Post-cardiotomy syndrome was the most frequent complication (n = 40, 4%). No difference was observed between the approaches in terms of complications and peri-operative outcomes, and when these were compared with the results of other centers. Conclusions: Patients undergoing surgical repair of congenital heart disease through a minimally invasive approach have excellent outcomes, regardless of the approach used.     

Psychopathology in young adults with congenital heart disease. Follow-up results

Aims The aim of the present study was to assess the occurrence ofa wide range of behavioural and emotional problems long-term(>9 years) after surgical correction for congenital heart diseasein infancy and childhood. Methods The problem scores on the Young Adult Self-Report of 166 19–25-year-oldadults with congenital heart disease were compared with thoseof subjects of similar age from the general population. Results On most Young Adult Self-Report scales no differences were foundbetween the mean problem scores of the congenital heart disease-adultsand reference peers. On only two Young Adult Self-Report scales(i.e. Somatic Complaints and Strange) and the total problemscore were significant though small differences found betweenthe mean problem scores of the congenital heart disease adultsand reference peers. No significant relationship was found betweencardiac diagnosis and problem behaviours in congenital heartdisease adults. No relationship was found between IQ scoresand problem behaviours in congenital heart disease adults. Conclusion Overall, it can be concluded that the results of the congenitalheart disease adults were not unfavourable, since the differencesin mean (total) problem scores between the congenital heartdisease sample and reference group were small and limited toonly two specific problem areas.     

Right ventricular performance in congenital heart disease: a physiologic and pathophysiologic perspective

Underappreciated is the fact that the right ventricle is often the primary determinant of long-term morbidity and mortality in patients with congenital heart disease. Right ventricular performance in these patients depends on a unique set of physiologic and pathophysiologic factors that are rarely considered in acquired heart disease. This article explores this unique physiology and pathophysiology in the hope that it will enhance understanding of a wide variety of congenital cardiac anomalies.     

同种带瓣管道在儿童先心病治疗中的应用

目的 :报告应用同种带瓣管道 (VHC)在儿童先心病治疗中的经验。方法 :全组 12例患儿男 7例 ,女 5例。平均年龄 7.5 (2 .2～ 13)岁 ,平均体重 2 1(12 .5～ 32 )kg。病种包括右室双出口 5例 ,共同动脉干 2例 ,矫正性大动脉转位合并室缺 2例 ,完全性大动脉转位 1例 ,法乐四联症合并肺动脉闭锁 1例 ,主动脉瓣关闭不全 1例。主动脉VHC应用 2例 ,肺动脉VHC应用 10例 ,均用于右室流出道重建。结果 :本组病例无手术死亡。平均随访 9.5 (3～ 19)个月 ,死亡 1例。存活患儿心功能明显改善 ,超声心动图检查显示吻合口无狭窄 ,VHC管腔通畅 ,瓣膜无明显返流。结论 :本组结果表明VHC是儿童先心病右室流出道重建的理想材料。     

Down综合征并发先天性心脏病的临床分析

目的：总结分析Down综合征（Down’s syndrome）并发的先天性心脏病畸形及血流动力学资料。方法：2008年7月-2012年10月,采用经胸二维超声心动图并彩色多普勒显像及右心导管／心血管造影检查方法,诊断36例并发先心病的Down综合征患者,本文通过36例临床资料分析,探讨Down综合征并发的先心病畸形及其血流动力学。结果：36例患者中室间隔缺损（VSD）10例,房室间隔缺损（AVSD）6例,动脉导管未闭（PDA）6例,房间隔缺损（ASD）2例,ASD＋PDA2例,ASD＋VSD1例,ASD＋PDA＋VSD1例,VSD＋PDA4例,PDA十二叶主动脉瓣（BAV）1例,法洛四联症（TOF）2例,TOF＋ASD1例,18例有肺动脉高压者,其中5例为阻力型肺动脉高压。结论：①Down综合征并发的心血管畸形中,以VSD、AVSD和PDA最为常见,并常并发ASD、TOF。②在无肺动脉狭窄的患者中,约50％并发有肺动脉高压。