先心病合并重度肺动脉高压双向分流的外科对策

目的:探讨先天性心脏病伴重度肺动脉高压双向分流的外科对策及疗效。方法:回顾分析32例患者的临床资料,其中,室间隔缺损(VSD)22例,VSD合并房间隔缺损(ASD)5例,动脉导管未闭5例。术前均有不同程度劳力后紫绀,心脏B超提示双向分流,术中测量平均肺动脉压/平均体循环压>0.85,平均0.90±0.15,采用心脏停跳手术6例,不停跳手术26例。房间隔均采用自体心包片做成单向活瓣,以减轻术后早期右心负荷。结果:早期死亡3例(9.4％,3/32)。术后早期均有明显低氧血症,呼吸机支持,平均35.26±17.59小时,无气管切开病例。随访2～86(平均23.6±17.2)月,晚期死亡2例(6.3％,2/32),顽固右心衰3例(9.4％,3/32),其余24例(75％,24/32)恢复良好。结论:先心病伴重度肺动脉高压部分双向分流的病例,采用浅低温心跳不停心内直视手术有利于心肺功能保护,术中作房间隔单向活瓣有利于其早期恢复。

Surgical treatment on congenital heart disease with severe pulmonary hypertension

Objective: To study the experience and efficacy of 32 patients with congenital heart disease combined with severe pulmonary hypertension. Methods:The clinical data of 32 patients were studied retrospectively. All the patients showed cyanosis after physical activity and accepted echocardiogram measure showed bi-directed shunt at the defects. The intracardiac malformation included ventricular septal defects (VSD) 22 cases, VSD with atrial septal defects (ASD) 5 cases, VSD with patent ductus arteriosus (PDA) 5 cases. Among 32 cases, 6 cases were accepted the operation on cardioplegic heart arrested, while 26 on beating heart. Using auto-pericardium repaired ASD and made a valve that allowed only right-to-left shunt. If no ASD, the valve was done at the oval fosse. Results: There were 3 cases of early surgical deaths (9.4%, 3/32). Every patient accompanied with hypoxia, and need more long mechanical support but no case needs tracheolaryngotomy. There were 2 (6. 3%, 2/32) cases of late deaths and 3 (9.4%, 3/32) cases of late heart function failure followed-up from two months to eighty-six months. The other patients (75%, 24/32) recovered well. Conclusion: On-pump with beating heart is an effective myocardial protective technique in patients with congenital heasrt disease combined with severe pulmonary hypertension. It contribute to early recovery for the patients with severe pulmonary hypertension by doing the valves on atrial septum.