部分房室隔缺损的外科治疗

目的 :总结部分房室隔缺损外科治疗的经验及效果。方法 :部分房室隔缺损病人 2 75例 ,年龄 9个月～ 6 0岁 ,平均 ( 14 4± 11 1)岁。男性 117例 ,女性 15 8例。术中见均有较大的原发孔缺损呈半圆形 ,二尖瓣裂隙为完全性的 179例 ,部分的为 81例 ,有二尖瓣双开口 1例。合并畸形有卵圆孔未闭4例 ,继发孔房间隔缺损 (房缺 ) 2 5例 ,左上腔静脉 4例 ,主动脉瓣下膜样狭窄 2例 ,动脉导管未闭 1例 ,单心房 2例 ,三房心 1例。所有病人均修复二尖瓣裂隙 ,以心包修补原发孔房缺。结果 :早期死亡 11例 ,4 %。晚期死亡 5例。其余病人经 6个月到 2 5年随诊 ,其中心功能已达Ⅰ级 2 0 6例 ,Ⅱ级 5 2例。晚期重度二尖瓣关闭不全 2例 ,行二尖瓣替换。Ⅲ度房室传导阻滞 6例 ,Ⅱ度房室传导阻滞 3例。结论 :对于部分房室隔缺损的病人一经发现需尽早手术治疗 ,妥善修复二尖瓣裂隙 ,严密闭合原发孔房缺 ,防止传导阻滞的发生 ,尽量修复三尖瓣关闭不全是取得良好远期效果的关键。

Surgical treatment of partial atrioventricular septal defect:the experience of 27 years

Aim:To review the clinical experience in surgical treatment of partial atrioventricular septal defect of 275 patients in the period of 27 years.Method:275 patients,aged 9 month to 60 years old and male 117,female 158,underwent surgical repair for partial atrioventricular septal defect.Concomitant cardiac anomalys,including left superior vena cava in 4 patients,PDA in 1,subaortic stenosis in 2,secundum atrial septal defect in 25,common atrium in 2 were also repaired.All were performed with repair of primum ASDs with pericardial patches and the suture of the cleft of mitral valves.Result:11 cases died perioperatively and 5 died lately.And the follow|up is 5 month to 25 years.Severe mitral valve regurgitation occurred in 2 patients and they were performed mitral valve replacement.Heart function was improved in most of patients.Conclusion:For patients of partial atrioventricular septal defect the proper repair of mitral valve and the closure of primum ASD and avoiding the damage of His bundle play important roles in good early and late result.