局限型主动脉瓣下狭窄的外科治疗

目的总结局限型主动脉瓣下狭窄外科手术治疗的临床经验。方法1999年7月～2002年12月我院共手术治疗14例局限型主动脉瓣下狭窄,患儿平均年龄为(5.14±3.92)岁。所有患儿均合并其他心脏畸形,并同期纠治合并畸形;均在体外循环下行瓣下纤维狭窄切除术,其中2例分别加行左室流出道部分肌肉切开术和肌肉切除术。结果本组无一例发生手术并发症和死亡,术后左室流出道残余压差较术前明显下降(P<0.001),手术前、后主动脉瓣返流程度的差异无显著性。平均随访17.8个月,无一例狭窄复发。结论局限型主动脉瓣下狭窄不是一种简单的良性病变;纤维嵴切除加部分肌肉切开和(或)切除术可有效治疗主动脉瓣下狭窄;术中彻底解除狭窄可预防狭窄复发。

Surgical management of discrete subaortic stenosis

Objective To summarize the experience of treatment of discrete subaortic stenosis(DSAS). Methods Between July 1999 and December 2002, 14 patients with mean age of 5.14 years complicated with other cardiac anomolies underwent DSAS operation. All operations were under taken in full cardiopulmonary bypass including single ridge resection in 12 patients. The remaining 2 patients with one of additional septal myotomy, and the other with additional septal myomectomy. The dual anomalies were repaired at the same time. Results There were no operative mortality or complications. The postoperative peak left ventricular outflow tract (LVOT) gradient reduced significantly in comparing with that of pre-operated(P<0.001). There was no significant difference of aortic regurgitation shown between the preoperatied and postoperated ones. Postoperative follow-up averaged 17.8 months with no recurrence. Conclusions DSAS is not a simple benign lesion.Ridge resection with septal myotomy or myomectomy can provide excellent relief of stenosis resulting in complete prevention of recurrence.