单纯肺动脉瓣疏通术初期治疗危重婴幼儿室间隔完整型肺动脉闭锁

目的:探讨低龄危重婴幼儿室间隔完整型肺动脉闭锁,及危重肺动脉瓣狭窄的初期外科治疗方法。方法:2009年6月至2013年6月,我院共对10例室间隔完整型肺动脉闭锁及2例危重肺动脉瓣狭窄婴幼儿患者,施行经胸正中切口非体外循环下,单纯肺动脉瓣疏通术(改良Brock术)治疗,术中保留动脉导管未闭,三尖瓣反流未做处理。患儿年龄2~9个月,体质量4.3~10kg,平均6.4kg。所有患者均合并动脉导管未闭及房间隔缺损或者卵圆孔未闭,术前患者末梢血氧饱和度62%~73%,平均69%。结果:本组围术期死亡1例(8.3%),死亡原因为术后持续低氧血症,其余11例术后均缺氧状态改善,经皮血氧饱和度上升至84%~93%,平均89%。术后测得肺动脉瓣跨瓣压差为11~28mmHg(1mmHg=0.133kPa),平均15.6mmHg,术后随访11例,PDA均闭合,三尖瓣反流由术前大量转为少量或者消失。结论:作为危重婴幼儿的初期治疗,对于发绀严重,生长发育差,不能耐受体外循环的危重室间隔完整型肺动脉闭锁及危重肺动脉瓣狭窄患儿,Brock术可获得满意的治疗效果。

Brock operation treatment of pulmonary atresia with intact ventricular septum

Objective：To summarize the Brock operation treatment of pulmonary atresia with intact ventricular septum（PA-IVS） and critical pulmonary stenosis in infants and neonates.Methods：From June 2009 to June 2013,a totle of 12 patients with PA-IVS and PS underwent initial Pulmonary valvotomy without CPB.Results：1 case（8.3％） was dead of hyoxemia during the early postoperative period.The systemic artery saturation raised to 84％-93％ （mean 89％） o The pulmonary gradient pressure which was measured immediately after operation was 11-28 mmHg（mean 15.6 mmHg） and was significant higher than preoperation.we found that PDA was closed.trieuspid valve regurgitation was obviously decreased.Conclusion：Pulmonary valvotomy is a safe and efective initial treatment of pulmonary atresia with intact ventrieular sepmm and in neonates and critical pulmonary stenosis in infants with serious cyanosis.