先天性左心室流出道梗阻的外科治疗

目的 :总结先天性左室流出道梗阻 (LVOTO)的外科治疗经验。方法 :分析我科 1998年 1月至 2 0 0 3年 7月 33例先天性LVOTO接受手术治疗的患者临床资料。年龄 1～ 5 5岁 ,平均 (14 9± 10 2 )岁。其中主动脉瓣膜狭窄 10例 (30 3% ) ;主动脉瓣下狭窄 18例 (5 4 5 % ) ;主动脉瓣上狭窄 3例 (9 1% ) ;复合狭窄 2例 (6 1% )。有合并畸形者 2 3例 (6 9 7% ) ,心内膜炎 2例 (6 1% )。主动脉瓣置换 7例 (2 1 2 % ) ,升主动脉加宽 3例 (9 1% ) ,主动脉根部和升主动脉加宽 2例 (6 1% )。对主动脉瓣换瓣的患者常规华法令抗凝治疗 ,并监测凝血酶原时间和国际标准指数。结果 :全组无早期死亡 ;随访 3～ 4 1个月 ,平均 (13 2± 6 8)个月 ,4例患者残留轻度梗阻 (12 2 % ) ;晚期死亡 1例 (3 0 % )术后 18个月死于感染性心内膜炎 ;其余患者恢复良好。结论 :对不同类型的先天性LVOTO选择合适的手术方式、同期处理合并畸型、加强术后随访是提高先天性LVOTO外科治疗疗效的关键。

Surgical treatment of congenital left ventricular outflow track obstruction

Objective: The aim was to summarize the experience of surgical treatment of congenital left ventricular outflow track obstruction(LVOTO). Method: Between January,1998 and July,2003,33 consecutive patients with congenital LVOTO underwent operations.The age was 1～55 years(mean 14.9±10.2 years) including aortic valve stenosis in 10 cases(30.3%),supravalvular aortic stenosis is 3 canses(9.1%),subvalvular stenosis in 18 cases(54.5%),and complex stenosis in 2 cases(6.1%).Concomitant lesions were in 23 cases and endocarditis were in 2 cases.Seven patients underwent mechanical aortic valve replacement(AVR).Three patients underwent ascending aorta enlarging.Two cases with complex stenosis underwent ascending aorta,root of aorta and annular enlarging.Took warfarin for anticoagulation treatment after AVR,and inspected prothromboplastin(PT) and international normal ratio(INR).Result:There was no early death.The follow-up was 3～41 months(mean 13.2±6.8 months),residual mild stenosis in 4 cases,one late death from endocarditis after 18 months.Conclusion:Chosing the appropriative procedure for different types of LVOTO,correcting associated lesions and careful following-up were the keys to improve the results of surgical treatment of LVOTO.