室间隔缺损684例外科治疗的回顾分析

目的 :总结 6 84例先天性心脏病室间隔缺损 (VSD)外科治疗的经验、教训及疗效。方法 :自 1988年 6月至 2 0 0 0年 6月收治VSD病人 6 84例 ,其中男性 36 3例 ,女性 32 1例 ,年龄 1 5岁～ 5 0岁 (平均年龄 10 4岁 ) ,其中施行补片 2 46例 ,直接缝合 438例 ;术中采用心脏不停跳下施术 85例。结果 :手术后死亡 6例 ,占 0 88% ;并发完全性房室传导阻滞 9例 ,术后残余分流7例 ,疗效满意。结论 :VSD是一种常见的先天性心脏病 ,根据VSD缺损的不同位置及大小 ,采取不同的手术径路及缝合修补的方法 ;心脏不停跳下VSD修补手术 ,与心脏停跳下VSD修补手术相比 ,不仅降低和防止术后低心排、残余分流等并发症 ,而且避免了心肌的缺血、缺氧和再灌注损伤 ;为了降低VSD合并肺动脉高压病人的死亡率 ,加强围手术期的处理是至关重要的

Review of surgical repair of ventricular septal defect for 684 patients

Objective To review the experience of surgical tec hn ique and results on 684 patients with ventricular septal defect (VSD).Me thod All patients with VSD,underwent operative repair from June 1988 to J une 2000.Their age ranged from 1 5 to 50 years(average 10 4 years).The defects were closed with dacron patch in 246 patients,and remainder patients,the direct suture method to close the defect were used.Eighty-five cases of VSD were oper ated under the beating heart under extracorporeal circulation.Results There were six operative deaths with a mortality rate of 0 88%,seven resid ual shunt and nine Ⅲ AVB after surgery.Conclusion VSD is a commo n congenital heart disease.According to the characteristics of different locatio n and size of VSD,the different operative methods and operative incision were pe rformed.As compared with repair of VSD under heart arrest,the repair of VSD unde r beating heart not only reduces and prevents complication such as low cardiac o utput syndrome and residual shunt after surgery,but also avoided damage of myoca rdial hypoxia and reperfusion injury.In order to reduce the morbidity and mortal ity,intensive perioperative management of VSD combine pulmonary hypertension is very important.