部分性房室通道及并发畸形的手术治疗

目的总结部分性房室通道及其并发畸形手术治疗的经验.方法 26例部分性房室通道病人,年龄5～58岁,平均(16.26±5.31)岁.并发冠状静脉窦顶膜缺如4例,左上腔残留3例,双孔二尖瓣、继发孔房缺、肺动脉狭窄各2例,动脉导管未闭、右上肺静脉异位引流、三房心、共同心房各1例.二尖瓣裂缺选用间断缝合,同期行二尖瓣成形术2例,三尖瓣成形术20例.房缺以心包片或Dacron片连续缝合修补.冠状静脉窦顶膜缺如合并左上腔2例术中插管转流,仍保留冠状静脉窦开口在右房内;另外2例经房缺补片将窦口隔入左房侧.1例左上腔静脉套带阻断,术中定时开放.1例双孔二尖瓣行瓣裂修补及瓣下结构修理,另1例只修补瓣裂.并发的其它畸形术中得到同期处理.结果26例病人全部存活,心肺功能均有明显改善.结论部分性房室通道手术治疗安全,妥善修补瓣膜裂缺矫正并发畸形是手术成功的关键.

Department of Cardiovacular First Affiliated Hospital

Aim To review the experience of surgical proceduce of partial ateioventricular canal defect(PACD).Method From 1973 to 2002,26 patients with PACD was studied.The mean age was 16.2 6 5.31 years(range 5 to 58 years).In these patients,combined cartdiac abnormality included unroofed coronary sinus in 4,persistent anomalous pulmonary in 2,pulmonary arterial stenosis in 2,patent ductus arteriosus in 1,super right venous venous connection in 3,double orifice of mitral valve in 2,seconed atrial septal defect connection in 3,double orifice of mitra lvalve in 2,seconed atrial septal defect anomalous pulmonary venousconnection in 1,cortriatriatum in 1 and common atria in 1.The cleft of mitral valve was sutured interrupted,and the primary atrial septal deect was repaired with pericardial or Dacron patch and sutured continusly.Other operatied technique included mitral valvuloplasty in 2 and tricuspid valvuloplasty in 2. Result All patients survived after operation and the cardiopulmonary function was improved. Conclusion The surgical procedure of PACD is satisfactory. Manegement of mitral valve cleft and combinid cardiac abnormality is important operatived technique.