新生儿复杂先天性心脏病外科治疗--一年经验回顾

目的回顾分析过去一年新生儿复杂先天性心脏病手术治疗结果.方法2004年5月～2005年5月我院新生儿手术临床资料.手术共完成21例,其中室间隔完整的大动脉转位(TGA/IVS)13例;合并室间隔缺损的大动脉转位(TGA/VSD)2例;右心室双出口(DORV、Taussing-Bing)1例;完全性肺静脉畸形引流(TAPVC)2例(心下型及心上型各1例);肺动脉闭锁(PAA)3例.分别行动脉调转术(ASO)16例,完全性肺静脉畸形引流矫治术2例,改良Blalock-Taussing手术3例(其中肺动脉瓣闭式扩张术2例).结果全组存活18例,死亡3例,死亡率14.3%.2例完全性大动脉转位,1例为冠状动脉壁内走行,术后死于低心排血量综合征,1例死于肺部感染.另1例为心上型完全性肺静脉畸形,术后因肺部感染导致肾功能衰竭死亡.结论准确认识新生儿复杂先天性心脏病的病理生理,是正确选择手术时机,提高围手术期治疗的关键.

Surgical Treatment of Neonatal Complex Congenital Heart Disease:One-Year Experiences

Objective:To review the experience on surgical treatment for neonatal complex cardiac disease in Fu Wai Hospital during the last year. Methods:To retrospectively analyzed 21 neonates with heart disease undergoing operation from May 2004 to May 2005. Fourteen neonates with transposition of great arteries (TGA) and intact ventricular septum,two with TGA and ventricular septal defect and one with double outlet right ventricle (Taussing-Bing)underwent artery switch operation(ASO). Two neonates withtotal anomalous pulmonary venous connection and one of infracardiac type and the other of intracardiac type,underwent anastomosis of aleft atrium with common vein stem.Three neinates with pulmonary artery atresia underwent modified blalock-Taussing, and two underwent Balloon pulmonary valvulotomy.Results: There were 3 deaths. The operative mortality was 14.3%. One with intramural coronary artery died of low cardiac output syndrome, one died of pulmonary infection, and the other one died of renal function insufficiency. Conclusions: The number of neonatal cardiac surgery was increased and the surgical results were improved in Fu Wai Hospital during the past year. Understanding the pathophysiology of neonatal complex congenital disease is important for the optional timing of operation and the perioperative management.