右心室双出口的外科治疗

目的 探讨右心室双出口的手术治疗效果。方法 对31例右心室双出口患者手术的临床资料分析。主动脉辨下室间隔缺损(VSD)型23例，肺动脉辨下VSD型2例，两大动脉瓣下VSD型5例，远离两大动脉VSD型1例。有肺动脉狭窄者21倒，肺动脉高压者7例。采用左心室-主动脉心内隧道连接26例，左心室-主动脉心内隧道并右心室．肺动脉心外同种带瓣主动脉管道连接2例，全腔静脉-肺动脉连接1例，双向Glenn手术2例。右心室流出道重建采用直接缝合1例，自体心包片加宽9例，跨瓣补片扩大至左右肺动脉分又或一侧肺动脉14例，同种带瓣主动脉血管片连接2例。结果 手术死亡3例。手术非致死并发症9倒治愈出院。随访无远期死亡，效果良好。结论 根据右心室双出口的解剖特点和不同类型，选择不同的根治或姑息手术方式，保证重建的左、右心室流出道畅通，是手术成功的关键技术。

Surgical treatment of double outlet of right ventricle

Objective To evaluate the results of surgical treatment of double-outlet of right ventricle(DORV). Methods The clinical data of 31 cases with double outlet of right ventricle were analyzed. The ventricular septal defect(VSD) was at subaortic in 23 cases, subpulmonary in 2, doubly committed in 5, and noncommitted in 1. There were pulmonary stenoses in 21 cases, pulmonary artery hypertension in 7. The surgical strategies in DORV included left ventricle aorta intraventricular tunnel connection in 26 patients, left ventricle-aorta intraventricular tunnel and right ventricle-pulmonary artery extracardial cryopreserved aoric homografts valved tube repaired in 2, extracardiac conduit total cavopulmonary artery connection in 1,bi-directional Glenn in 2. The right ventricular outflow tract reconstructions were done by incision closed in 1 case, using a patch of autologus pericardium in 9, a transannular patch of autologus pericardium in 14, cryopreserved aortic homografts valved in 2. Results There were 3 operative deaths. 9 patients were discharged from hospital when non-fatal complications were cured. There was no long-term death, with better results. Conclusion Depending upon anatomic features and different forms of hypoplasia of DORV, the radical operation and palliative operation can be achieved with excellent clinical outcome. Reconstruction of the left and right ventricular outflow tract is essential procedure to the surgical success.