室间隔缺损合并“临界”肺动脉高压的手术治疗

目的探讨室缺合并临界肺动脉高压患者(Heath分级Ⅲ级)的临床治疗、手术适应证和围术期处理.方法选择8例重度肺高压患者,均经内科综合性处理,且有良性转归条件,实施室间隔修补并增设房间隔活瓣的改良手术.结果手术前后对比,血液动力学指标有明显改善.平均随访2.8年,良好7例,差1例(mPAP＞6.6kPa).结论房间隔活瓣可防止术后肺动脉高压危象,对内科综合性治疗反应敏感的患者,手术能取得明显的效果.

Operative treatment of ventricular septal defect complicated by "critical" pulmonary hypertension

Objective: To study the patients of ventricular septal defect associated with critical pulmonary hypertension in clinical treatment, perioperative therapy and operative indications. Method: 8 cases with severe pulmonary hypertension were selected and operated with repair of VSD and in addition, to perform an artificial atrial septal valve in case of original pulmonary hypertension was improved by comprehensive measures and benign conversion appeared. Result: Compared with pre and post operation, remarkable changes took place in hemodynamic parameters. Followed up for mean 2.8 years, good in 7 cases, one remained mPAP>6.6 kPa. Conclusion: The way of atrial septal valve formation is able to prevent the occurrence of critical pulmonary hypertension postoperatively. Only patients who are effective to comprehensive measures, the result of operation can get marked improvement.