完全性房室通道的外科治疗

目的总结94例完全性房室通道(com p lete atrioven tricu lar cana l defect,CAVCD)的外科治疗经验。方法一期手术矫治CAVCD 94例,房、室间隔缺损修补用双片法(涤纶片+心包片)65例,单片法29例,术中行房室瓣成形,并同期修补合并畸形。结果全组死亡10例(10.6%),其中<6个月者4例。4例术后出现二尖瓣中至大量反流,心肺功能衰竭死亡,3例因肺动脉高压危象死亡,3例分别死于低心排血量、脑并发症和气胸。随访84例,随访时间3~6个月,超声心动图复查二尖瓣轻度反流18例,轻至中度反流12例。结论严重二尖瓣关闭不全和肺动脉高压危象是CAVCD矫治术后主要的死亡原因,早期手术矫治和确切的房室瓣成形可获得较好的手术效果,术中常规使用食管超声心动图对提高手术疗效具有重要的作用。

Surgical Treatment of Complete Atrioventricular Canal Defect

Objective To summarize the experience of surgical treatment of complete atrioventricular canal defect(CAVCD) in 94 patients.Methods Ninety-four patients with CAVCD underwent surgical therapy.CAVCD were repaired by using two-patch technique in 65 patients and using single-patch technique in 29 patients.Additional cardiovascular anomalies were corrected simultaneously.Results There were 10 hospital deaths(10.6%),4 patients were less than 6 month old.Four patients died of severe mitral valve regurgitation,3 died of pulmonary hypertensive crises and 3 died of low cardiac output syndrome,cerebral complications and aerothorax separately. Follow-up was completed in 84 patients,with a duration of 3-6 months.Mild degree mitral valve regurgitation was observed in 18 patients by echocardiography,mild to middle degree mitral valve regurgitation was observed in 12 patients.Conclusions Postoperative severe mitral regurgitation and pulmonary hypertensive crises were the main cause of deaths for correction of CAVCD.Early correction of CAVCD and satisfactory reconstruction of atrioventricular valve could obtain a satisfactory result,routine evaluation with intraoperative transesophageal echocardiography could result in a low operative mortality.