干下型室间隔缺损法乐氏四联症20例临床分析

本文对253例法乐氏四联症中20例(7.9%)室间隔缺损位于肺动脉瓣下者的临床资料及手术结果分析表明,本组患者临床上紫绀多偏轻;B型超声心动图及心室造影显示,右心室流出道较宽,肺动脉发育不良亦少见。但绝大多数病例需补片加宽右室流出道或跨环补片,否则术后易残留右心排血受阻。

TETRALOGY OF FALLOT WITH SUBPULMONARY VENTRICULAR SEPTAL DEFECT

Among a total of 253 patients (aged 5.5-32 years) with tetralogy of Fallot, 20 (7.9%) with tetralogy and subpulmonary ventricular septal defect (VSD) had undergone intracardiac repair between Jan. 1988 and Dec. 1990 with no early operative death. In contrast to the "classic" tetralogy of Fallot, most of the patients with subpulmonary VSD had less severe cyanosis. All patients had two-dimensional echocardiography examination, angiocardiographic studies were done in 13 patients. The supraventricular crista was absent in 17 patients, and hypoplastic in 3. Pulmonary artery developed normally in all but 1, no hypoplastic left ventricle was found. A vertical ventriculotomy in the outflow portion of the right ventricle was made, VSD was repaired with a patch. Simple infundibular resection was performed in one patient (5%); infundihular patch-graft in 6 (30%), patchgraft across the pulmonary valve ring in 13 (65%) which was higher (p<0.001) than that of classic tetralogy of Fallot (18.6%). All patients were in good condition but one with residual pulmonary stenosis as followed up for 5 to 21 months. The right ventricular outflow tract in this group of patients was larger in diamter than in the classic type, and usually the main, right and left pulmonary arteries were developed in most of the patients, but when the VSD was closed surgically, the pulmonary valve ring and right ventricular outflow tract stenosis usually became more se vere, and therefore patchgraft across the ring was often needed.