心肺联合移植治疗艾森曼格综合征二例

目的总结心肺联合移植术治疗艾森曼格综合征的围术期经验。方法对2例先天性心脏病合并艾森曼格氏综合征患者施行同种异体原位心肺联合移植术。采用改良St．Thomas心脏停搏液和改良LPD液保护供体心肺。小心去除患者心、肺,胸腔及纵隔彻底止血后,置入供体心肺,采用双腔静脉术式,依次吻合气管,上、下腔静脉和主动脉。术后对患者进行密切监护,积极防治排斥反应和感染,及时处理并发症。结果手术均获成功。气管吻合口狭窄,经气管袖式切除后改善。目前2名患者均恢复正常工作生活。结论良好的心肺保护,精细的手术操作和正确的术后处理是心肺联合移植成功的关键。

Experience in treatment of Eisenmenger's syndrome by heart-lung transplantation

OBJECTIVE: To summarize the experience in treatment of Eisenmenger's syndrome by heart-lung transplantation (HLT). METHODS: Two cases of congenital heart disease with Eisenmenger's syndrome, aged 20 and 22, underwent bicaval orthotopic HLT. Modified St. Thomas cardioplegic solution and modified LPD solution were used to preserve the donor heart and lung. After removing the heart and lung of the recipient and thorough hemostasis in thoracic cavity and mediastinal septum, the donor heart and lung was implanted, and trachea, superior/inferior vena cava and aortic artery were anastomosed gradually. Intensive care against infection, rejection and other complications were performed after operation. RESULTS: The operations were successful. Tracheal anastomotic stenosis happened in one case seven months after HLT and was cured by sleeve resection of the stenosed trachea segment. Acute rejection happened in one case 10 days after HLT and was cured by stoss therapy. Both patients recovered to normal life and work. CONCLUSION: The success of HLT is related to perfect organ preservation, precise surgical performance and proper peri-operative treatment.