手术联合介入封堵体肺动脉侧支矫治法洛四联症短期效果

目的 评价手术联合介入封堵体肺动脉侧支矫治法洛四联症的临床应用价值.方法 2004年10月至2008年5月,采取手术联合介入封堵大的体肺动脉侧支矫治法洛四联症8例.心血管造影诊断体肺动脉侧支血管25支,行介入封堵20支,其余5支侧支血管较细,未作处理.手术均采用中度低温体外循环下进行,采用涤纶补片修复室间隔缺损,右心室流出道彻底疏通.结果 全组患者无围手术期死亡,无肺部严重渗出、肾衰竭、严重低心排血量综合征等并发症,也无介入封堵相关并发症,发生低氧血症1例,经治疗后恢复正常.术后随访6个月,NYHA心功能分级Ⅰ级7例,Ⅱ级1例.结论 介入封堵体肺动脉侧支与心内矫治手术联合治疗伴有大的体肺动脉侧支的法洛四联症,能减少回心血流量,利于手术操作,进而提高一期根治的成功率.

Short-term outcome of surgery combined with embolization of major aortopulmonary collateral vessel for tetralogy of Fallot

Objective To demonstrate clinical value of surgical repair combined with collateral embolization for tetralogy of Fallot with major aortopulmonary collateral arteries (MAPCAs).Methods The clinical catheterization and surgical data of 8 such patients from October 2004 to May 2008 were analyzed retrospectively.All 8 patients underwent completely surgical repair combined with MAPCAs occlusion.Of 25 collateral arteries,20 were occluded before surgical procedure and 5 small ones were left.Corrective repairs were accomplished under moderate hypothermic cardiopulmonary bypass.Ventricular septal defect was closed with Dacron patch,and all patients underwent non-valved autologous right ventricular outflow tract reconstruction.Results No complications were observed,only 1 patient got hypoxemia.Blood returned to left atrium from lung was decreased.During 6 months follow-up,7 cases were in NYHA class Ⅰ,another was in NYHA class Ⅱ.Conclusions In selective patients with dual pulmonary blood supply by both MAPCAs and native pulmonary arteries,this combined therapy of collateral embolization and surgical repair simplifies copmpleling surgical procedure,improves surgical results and achieves higher rate of one-stage repair.