小儿主动脉缩窄的外科治疗

目的 回顾和总结小儿主动脉缩窄的外科治疗经验。方法 66例患儿，年龄20d～8．5岁。21例单纯CoA，45例同时合并心内畸形。单纯CoA从左后外侧第4肋间进胸。若合并有心内畸形，早期9例患儿先左后外侧肋间进胸纠治CoA，再正面开胸体外循环下纠治心内畸形，2000年1月之后，35例采取正中劈开胸骨，体外循环下Ⅰ期纠治CoA和心内畸形。另有1例分期手术。纠治CoA方法主要有：缩窄段切除行端端吻合或端侧吻合术，补片扩大成形术和左锁骨下动脉瓣翻转成形术。结果 患儿术后早期下肢动脉血压超过上肢47例，与上肢相同13例，仍低于上肢6例，无一例发生肾功能衰竭和截瘫。死亡2例(1例死于严重心力衰竭，另1例死于心律失常)。随访39例，下肢动脉血压超过上肢34例，相同4例，1例伴有主动脉弓发育不良术后6个月仍存在缩窄(上肢血压高于下肢35mmHg)。3例有声音嘶哑，远期随访无高血压出现。结论 单纯主动脉缩窄或合并心内畸形宜早期手术治疗，Ⅰ期根治术是安全和有效的。

Surgical treatment for coarctation of aorta in children

Objective To sum up the experiences of surgical treatment for coarctation of aorta (CoA) in children.Methods 66 patients with their ages ranged from 20 days to 8.5 years were included. The types were isolated CoA ( n =21) and CoA associated with intracardia anomalies ( n =45). For isolated CoA patients, the fourth left posterior lateral intercostal thoracotomy was used. After January 2000, single stage repair for the CoA associated cardia anomalies was successfully performed via a midline sternotomy using cardiopulmonary bypass with deep hypothermia and either total circulatory arrest or low flow perfusion. Only 1 patient required a two stage repair for his CoA and associated VSD. The types of surgical procedures mainly included resection and direct end to end anastomosis, subclavian flap aortoplasty technique and synthetic patch aortoplasty.Results At early stage after operation, blood pressure of lower extremity was higher ( n =47), same and lower than upper extremity in 47, 13 and 6 patients respectively.There was no paraplegia, kidney failure, chylothorax and subclavian steal blood syndrome. one patient died of heart failure and another one died of arrhythmia.Long term follow up was available in 39 out of the 64 survivors. No patients had systemic hypertension. The other long term complications included hoarseness ( n =3) and a patient with aortic arch hypoplasia had the recurrent obstruction after operation six months later.Conclusions We advocate early operation for all patients with coarctation of aorta. Single stage repair of CoA associated cardia anomalies via a midline sternotomy using cardiopulmonary bypass is safe and effective.