肺动脉环缩术在儿童复杂先天性心脏病中的应用

目的 探讨肺动脉环缩术在儿童复杂先天性心脏病中的应用经验,并对手术效果进行评价.方法 回顾性分析2002年1月～2007年3月进行的32例肺动脉环缩术.男22例,女10例,手术年龄平均9.2个月,体重平均6.1 kg.肺动脉环缩后肺动脉周径平均(28.0±4.1)mm,术后估测环缩近远端压差(43.7±9.0)mmHg.结果 围术期死亡1例,2例患儿再次调整环缩.4例患儿出现围术期并发症.31例患儿随访1个月～5年,22例患儿进行Ⅱ期手术.结论 肺动脉环缩术可限制肺血过多,锻炼左心室,为Ⅱ期施行双心室矫治及双向腔肺分流术赢得时机.

Application of pulmonary artery banding for complex congenital heart defects in children

Objective To discuss the application of pulmonary artery banding(PAB)in the treatment of complex congenital heart defect in children and evaluate the result of the procedure.Methods Thirty-two children with complex congenital heart defects underwent pulmonary artery banding procedure in our center from Jan 2002 to Mar 2007.There are 22 boys and 10 girls,the mean age was(9.2±18.0)months,the mean body weight was(6.1±3.9)kg,the mean saturation was(89.5±6.3)%.The diameter of main pulmonary artery was(16.3±3.0)mm by echocardiography and mean pulmonary artery pressure was(44.5±7.6)mmHg before operation.The mean postoperative circumstance of main pulmonary artery was(28.0±4.1)mm,and the mean pressure gradient over the banding was(43.7±9.0)mmHg.Results There was one postoperative death because of infection,and 2 cases underwent rebanding procedure.The mean ventilation time was(44.3±164.9)hrs and the mean ICU stay time was(4.1±7.1)d.The postoperative saturation was(82.7±9.1)%.The morbidity was 4/31.Thirty-one cases were followed up from 1 month to 5 years.Twenty-two cases un derwent the 2nd stage procedure while the banding belts were taken down and 11 cases underwent the pulmonary artery angioplasty.Conclusions The pulmonaty artery banding procedure can limit the pulmonary blood flow to protect the pulmonary vessels and retrain the left ventricle in d-TGA cases.It is a safe palliative procedure with satisfying operative results,followed by biventricular repair or univentricular repair as further surgical intervention.