儿童完全性房室隔缺损的外科治疗

目的总结40例儿童完全性房室隔缺损（comple atrlovcntricular septal defect，CAVSD）的外科治疗经验，以提高手术治疗效果。方法RastelliA型32例，B型1例，C型7例。40例CAVSD（不包括过渡型）中22例采用单片心包补片法纠治，18例用双片法纠治。结果手术死亡3例，死亡率7．5％。死亡原因：1例因重度肺动脉高压出现肺动脉高压危象及心肺功能衰竭；1例Ⅲ度房室传导阻滞及严重低心排；1例合并主动脉缩窄及右室双出口术后12天死于感染性心内膜炎。远期死亡1例，为二尖瓣返流并发肺炎心力衰竭。结论CAVSD易在早期并发梗阻性肺血管疾病，手术应在3～12个月内进行。手术要点除完善闭合房室隔缺损外，特别注意恢复二尖瓣功能；术后处理应严格防治肺动脉高压，控制血压，以减轻二尖瓣再损伤和反流。

Surgical Correction of Complete Atrioventricular Septal Defect in Children

Objective To summarize surgical treatment experiences of 40 children with complete atrloventricular septal defect（ CAVSD）, in order to increase operative effect. Methods Rastelli type A had 32 cases, type B 1 case and type C 7 cases. Among 40 cases with CAVSD（type transitional not included）, the single pericardiac The one - patch repair was used for 22 cases and the two - patch repair for 18 cases. Results 3 patients died and the operative mortality was 7. 5%. Of the 3 early death, One was due to severe pulmonary hypertension, cardiac and pulmonary function failure; One died of severe pulmonary hypertention; One died of Ⅲ.A - V block and severe low cardiac outflow syndrome. The other case with coarctation and double outflow of right ventricle died of infective endocarditis . One late death was due to mitral regurgitation with pneumonia and heart failure. Conclusion The pulmonary vascular obstructive disease can develop within one year of age with CAVSD, the operation should be done between 3 months and 1 year. The main points of operation must be restoration of good mitral valve function besides complete close of AVSD. Postoperative monitor includes lower pulmonary hypertension, to control hypertension and to use the medicine decreasing afterload of left heart so as to alleviate the mitral regurgitation and repeated injury.