新生儿及婴儿危重型肺动脉狭窄及肺动脉膜性闭锁的外科治疗

目的:总结我科1997年4月至2007年8月对新生儿及婴儿室间隔完整型肺动脉闭锁及危重型肺动脉瓣狭窄的手术治疗经验。方法:手术治疗共23例,年龄6d~11个月。其中室间隔完整型肺动脉膜性闭锁10例,危重型肺动脉瓣狭窄13例。19例经胸正中切口体外循环下心脏不停跳完成手术,4例应用左胸后外侧切口非体外循环方法。除早期1例同期行动脉导管未闭(PDA)结扎及卵圆孔未闭(PFO)缝合外,其余22例均采用保留PDA、单纯切开肺动脉瓣的方法。结果:围手术期死亡2例,分别死于低氧血症及急性肾功能衰竭。术后当日超声心动图测肺动脉跨瓣压差为37~132mmHg(1mmHg=0.133kPa),平均61mmHg。2周后复查示肺动脉跨瓣压差为26~77mmHg,平均43mmHg,较术后早期明显降低(P<0.05)。出院前不吸氧下测动脉血氧饱和度78%~92%,平均85%,较术前明显增高(P<0.05)。随访4个月至10年,平均5.8年。PDA均闭合,肺动脉血流通畅,三尖瓣返流消失或明显减轻。结论:保留动脉导管、单纯肺动脉瓣切开术对于治疗新生儿及婴儿室间隔完整型肺动脉膜性闭锁及危重型肺动脉瓣狭窄是一种安全有效的方法。

Surgical Treatment of Pulmonary Atresia With Intact Ventricular septum and Critical Pulmonary stenosis in neonates and infants

Objective： To summarize the experience of surgical treatment of pulmonary atresia with intact ventricular septum and critical pulmonary stenosis in neonates and infants. Method：From Apr. 1997 to Aug. 2007, a total of 23 patients （10 pulmonary atresia and 13 critical pulmonary stenosis） underwent initial pulmonary valvotomy, whose age ranged from 6 days to 11 months. 19 cases were performed via median stemotomy with bypass by beating heart, 4 cases using lateral-thorax incision without bypass. The pulmonary valvotomy were performed in all of the patients except 1 case who combined with PDA ligation and PFO closure simultaneity in the early period. Result： 2 cases were dead of hypoxemia and acute renal dysfunction respectively during the early postoperative period. The pulmonary gradient pressure which was measured immediately by ECHO after operation was 37 - 132 mmHg （mean 61 mmHg） and was reduced to 26 - 77 mmHg （mean 43 mmHg） 2 weeks later （P 〈 0.05）. The systemic artery saturation raised to 78% - 92% （mean 85% ） before discharge and was significant higher than preoperation （ P 〈 0.05）. After 4 months to 10 years of follow-up, the ductus was found closed spontaneously in all patients and the tricuspid valve regurgitation was disappeared. Conclusion： Pulmonary valvotomy is an safe and effective palliative procedure for surgical treatment of pulmonary atresia with intact ventricular septum and critical pulmonary stenosis in neonates and infants.