体外循环下闭合重症未闭动脉导管体外循环的经验体会

<正> 动脉导管未闭(PDA)合并重症肺动脉高压,血管弹性较差者,用导管结扎或切断缝合术,可能发生导管破裂大出血。PDA 合并室间隔缺损或其它心内畸形者,经正中切口一期完成手术,用常规方法解剖游离动脉导管比较困难,出血危险性也较大,有些病例结扎动脉导管后,可能发生急性心衰。Kirklin 在1961年报告了在低温体外循环下,短暂停循环,经主肺动脉切口,直接缝合关闭 Potts 手术的吻合口,同期完成法乐氏四联症根治手术,取得成功,这一经验被以后的作者吸取应用。对于粗大的动脉导管,有肺动脉高压的,有钙化形成的,有感染性心内膜炎的,有动脉瘤形成的,高年龄的,再通的动脉导管,或合并其它心内畸形的动脉导管,用体外循环或深低温、停循环方法,经肺动脉或主动脉切口,直接缝闭动脉导管,取得较好结果,减少了常温手术下直接结扎缝合此类动脉导管出血的并发症。

The Experience of closure of large patent ductus

The experience about closure of 23 cases of large patent ductus arteriosus (PDA)under cardiopulmonary bypass(CPB)were reported.17 cases associated with ventricular septal defect(VSD) ,3 cases with pulmonary hypertension(PH),one with F3,one with F4,one with partial anomalous pulmonary venous return.One ductus was tied under CPB.The other 22 were closed through pulmonary artery.20 operations were carried out under deep hypothermia,low flow perfusion,and Tredelenburg's positon.In 21 cases the PDA were closed and the intracardiac anomalies were corrected in the same settting. 21 patients awoke after operation.One awoke in the evening of the operating day.2 patients associated with VSD ahd PH died.The authors believe that bleeding from the ductus can be avoided by using this mothod.Closure of PDA and correction of the intracardiac anomalies at the same operation is save,and there is no cerebral air embolism and perfusion lung in this group.