左旋心和孤立左位心的诊断与外科治疗

【目的】分析探讨左旋心和孤立左位心的诊断和外科治疗。【方法】总结了9例左旋心和3例孤立左位心的临床资料，对其诊断和治疗进行了分析。【结果】左旋心和孤立左位心的诊断主要依靠肺门切层片或高KV胸片和胸腹部平片。左旋心平均心血管畸形数为4.8±1.8，孤立左位心为3.0±1.7。手术方法主要有改良Fontan术和全腔静脉肺动脉连接术、Rastelli术、手术探查等。手术存活6例，其中改良Fontan术和全腔静脉-肺动脉吻合术占3例，Rastelli术为1例。【结论】①左旋心和孤立左位心的诊断主要依靠肺门切层片或高KV胸片和胸腹部平片。②改良Fontan术和全腔静脉-肺动脉连接术为治疗复杂先心病较有前途术式。③肺动脉高压、肺血管发育不良、房室瓣返流和心肌损伤是外科治疗复杂先心病的四大危险因素。④左旋心和孤立左位心合并的心血管畸形比较复杂。

The Diagnosis and Surgical Management of Levoversion and Isolated Levocardia

【Objective】 To analyze and explore the diagnosis and surgicaltreatment of levoversion and isolated levocardia. 【Method】 9 cases of levoversion and 3 cases of isolated levocardia were investigated. 【Results】 The diagnoses of levoversion and isolated levocardia could be confirmed only by hilum-tomography or high KV chest plain film and thoracic-abdominal plain X-ray, which can give the morphology of bronchi, the position of the liver and the direction of the apex, because there is a constant relation between bronchi, venous atria and great lobe of liver. Levoversion and isolated levocardia usually accompany with several defects in cardia. There was 4.8±1.7 mean abnormalities in levoversion, 3.0±1.7 in isolated levocardia. Surgical approaches were as follow: modified Fontan operation or total cavopulmonary connection, Rastelli operation, surgical exploration. The surgical survival rate was 75% in the these patients who had undergone modified Fontan or total cavopulmonary connection. 【Conclusions】 ①Levoversion and isolated levocardia were diagnosed mainly by hilum-tomography/high KV chest plain film and thoracic-abdominal plain X-ray. ②Modified Fontan and total cavopulmonary connection is a hopeful procedure for the surgical treatment of complex CHD. ③Pulmonary hypertension, hypoplasia of pulmonary artery, myocardiac strain and the residual lesions were the major risk factors of surgical management of C-CHD in this series. ④Levoversion is the postion associated with complex cardiovascular lesions