小儿永存动脉干9例外科诊治

目的:总结9例小儿永存动脉干(PTA)外科治疗的经验。方法:1994年4月至2004年3月外科手术纠治9例PTA。年龄18个月～6岁,体重6.5～18kg。按VanPraagh分型,A1型5例,A2型2例,A3及A4型各1例。右心室肺动脉流出道重建,均用同种带瓣主动脉。结果:PTA发病率0.36%,死亡率11.1%(19)。早期死亡l例,早期并发肺部感染1例,术后随访6例,1例残余室间隔缺损(VSD),1例残余右心室流出道梗阻,2例主动脉瓣轻度关闭不全,1例主动脉瓣中度关闭不全。结论:PTA易早期并发肺血管梗阻性疾病,应尽早纠治。手术要点是防止VSD残余分流;分离肺动脉和修复动脉干缺损时,应避免损伤动脉干瓣膜及冠状动脉口。

Surgical correction of 9 children with persistent trucus arteriosus

Objective:To review the expericnce of surgical correction of persistent truncus arteriosus(PTA)Method:From April.1994 to March 2004,nine children with PTA,aged 18 months-6 years,weighed 6 ^5-18 kg,underwent surgical correction.There were 5 cases with type A1,2 type A2, each 1 type A3 and A4 according to Van Praagh's classification.In reconstruction of right ventricle to pulmonary outflow tract,aortic homograft were used in all cases.Result:PTA is rare among cardiovascular diseaes (0 ^36%).The operative mortality rate was 11 ^9% (1/9).Early death occurred in one case.Early pulmonary infection in 1.6cases were followed up in 1-6a.residual shunt in 1,residual right ventricular outflow tract stenosis in 1,lighter arotic regurgitation in 2,middle arotic regurgitation in 1.Conclusion:PTA is apt to develop pulmonary vascular obstructive disease early and correction should be done before one year.Surgical main points:Residual VSD has to be avoided;Careful attention to the truncal value and coronary ostia is critical when the pulmonary artery is dissected and the truncal defect is repaired.