双向格林手术后房室瓣反流加重的原因分析

目的 探讨双向格林手术后房室瓣反流加重的原因.方法 2009年至2014年共523例患儿实施单纯的双向格林手术,其中术前存在左侧(体循环房室瓣)或共同房室瓣反流者420例,按原发畸形的种类及术前对房室瓣的描述加以登记.大多数患儿采用非体外循环下实施双向格林手术.术后复查心脏彩超评估房室瓣的反流变化.结果 术后体循环房室瓣反流改善的391例,术后体循环房室瓣反流无改善的18例,术后体循环房室瓣反流量增加的11例,其中死亡2例.术后体循环房室瓣反流少量及以下者,平均呼吸机辅助时间(6.3±2.4) h,术后房室瓣反流无改善或反流加重的患儿,平均呼吸机辅助时间(30.6±4.8)h.体循环房室瓣反流改善组患儿的原发畸形均为单心室类,体循环房室瓣反流于术后无改善者中8例为单心室畸形,10例为双心室类畸形,体循环房室瓣反流于术后加重者均为双心室类畸形.结论 双向格林术后原有的体循环房室瓣反流增加主要发生在双心室类畸形的患儿,术前房室瓣结构明显发育异常也是术后反流无改善的重要因素.

Causes of aggravating atrioventricular valve regurgitation after bidirectional cavopulmonary anastomosis

Objective To explore the causes of aggravating atrioventricular valve regurgitation after bidirectional cavopulmonary anastomosis.Methods From 2009 to 2014, a total of 523 children underwent simple bidirectional cavopulmonary anastomosis.And 420 cases had preoperative regurgitation of left side (systemic atrioventricular valve) or common atrioventricular valve.According to the types of primary deformity and preoperative registration of atrioventricular valve.Most patients underwent bidirectional cavopulmonary anastomosis by extracorporeal circulation.Postoperative ultrasonic reviews were conducted for monitoring the changes of atrioventricular valve regurgitation.Results After operations, systemic atrioventricular valve regurgitation improved (n=391), postoperative, systemic atrioventricular valve regurgitation showed no improvement (n=18), systemic atrioventricular valve regurgitation increased (n=11) and mortality occurred (n=2).In mild cases of atrioventricular valve regurgitation, the average breathing machine assisting time (6.3±2.4) h;in non-improving or aggravating cases, the average breathing machine assisting time (30.6±4.8) h.Atrioventricular valve regurgitation improved in all patients with primary anomalies of single ventricle.Atrioventricular valve showed no improvement for single ventricle deformity (n=8) and double ventricular class deformity (n=10).Atrioventricular valve regurgitation aggravated in all double ventricular cases.Conclusions After bidirectional cavopulmonary anastomosis, atrioventricular valve regurgitation increases predominatly in double ventricular cases.And preoperative dysplasia of atrioventricular valve structure is also an important factor of non-improving regurgitation.