小于6个月先天性心脏病患儿的外科治疗

目的 回顾总结小于6个月婴幼儿先天性心脏病的外科治疗.方法 2000年1月～2006年12月,手术纠治年龄小于6个月先天性心脏病1831例.包括:室间隔缺损并肺动脉高压453例,完全性大动脉错位214例、法乐四联症119例、完全性肺静脉异位引流106例、右室双出口69例、肺动脉瓣狭窄65例,完全性房室通道55例、动脉导管未闭53例、主动脉缩窄伴室间隔缺损46例、肺动脉闭锁伴室间隔缺损36例、肺动脉闭锁室间隔完整型31例、主动脉弓中断24例、右室双出口伴肺动脉瓣下室间隔缺损22例、其他538例.根据不同病种采取相应的手术方法纠治.结果 手术死亡98例,手术死亡率5.35%.随着手术方法不断改进,手术总死亡率从2000年的8.23%降至2006年的4.91%.随访:完全性大动脉错位术后发生室间隔残余漏1例,肺动脉瓣上狭窄5例,主动脉瓣上狭窄2例,主动脉瓣下狭窄1例,其中再次手术4例,远期死亡1例;完全性肺静脉异位引流心内型4例在术后出现肺静脉回流梗阻,2例死亡,2例再次手术解除梗阻.早期室间隔缺损术后发生残余漏5例,分流量小,不需再次手术;其余病例随访不完整.结论 婴幼儿先天性心脏病的手术处理时间非常重要,危重复杂型先天性心脏病如不早期手术,将失去手术机会,增加术后危险性和死亡率.

Repair of congenital heart disease in 1831 infants under the age of six months

Objective To review our experience of surgical repair of congenital heart disease in infants under 6 months of age.Methods Between January 2000 and December 2006.one thousand eight hundred and thirty one infants were operated on.There were 204 complete transposition of the great arteries(TGA),106 total abnormal pulmonary venous connection(TAPVC),119 Tetralogy of Fallot,69 double outlet right ventricle,55 Complete atriventricular defect,46 coarctation of aorta with ventricular septal defect,36 pulmonary atrisia with ventricular septal defect,31 pulmonary atrisia with intact ventricle septat,24 Interrupted aortic arch,22 Taussig-Bing,453 ventricular septal defect with pulmonary hypertension.Results There were 98 operative deaths with total mortality rate of 5.4 %.With improvemenr of surgical procedures,the mortality decreased from 8.23% in 2000 to 4.9 % in 2006.In the TGA group,there were one residual VSD,5 pulmonary super valve obstruction,2 aortic super valve obstruction and one with aortic sub-valvular obstruction,4 patients were re-operated on.Four patients with intracardiac type of TAPVC had venous return obstruction.two patients died and another two were re-operated on.In the VSD group,there were 5 patients with residual VSD at early stage,which required no repair.Conclusions The timing of surgical repair is very important,especially for complex congenital heart disease.The best operative procedure will be lost,if the infants is repaired late when the operative morbidity and mortality are increased.