完全性房室间隔缺损合并法乐四联症的手术矫正

目的　报告完全性房室间隔缺损合并法乐四联症的外科治疗。　方法　 6例患者 ,年龄 3～ 9岁 ,均施行手术根治 ,经右房 右室切口修补VSD ,房室间隔缺损采用两块补片技术修复 ,左房室瓣裂隙的修复均采用间断缝合 ,右室流出道均用带单瓣的补片跨瓣加宽。　结果　全组 6例术后出现低心排综合征、多器官衰竭、灌注肺并发症各 1例 ,早期死亡 1例为多器官衰竭者 ,5例长期存活。术后随访 6个月～ 5 5年 ,1例有轻度左房室瓣关闭不全。心功能Ⅰ级 4例 ,Ⅱ级 1例。　结论　完全性房室间隔缺损合并法乐四联症可应用 2块补片法行手术根治 ,左房室瓣瓣裂的常规修补可降低其关闭不全的发生率 ,大部分患者术后心功能可获得良好的改善。

Surgical correction of complete atrioventricular septal defect with tetralogy of Fallot

Objective To report the surgical correction of complete atrioventricular septal defect with tetralogy of Fallot (AVSD TOF). Methods Six consecutive patients aged 3 9 years underwent correction of complete AVSD TOF. The two patch technique for atrioventricular septal defect was used. The ventricular septal defect was closed through a right ventriculotomy and right atriotomy in each case. The commissure between the superior and inferior bridging leaflets of the left portion of the common atrioventricular valve was closed in each patient. RVOT obstruction was relieved by a transannular autologous pericardium with monocuspid valve. Results Postoperative complications included respiratory failure in 1 patient, low cardiac output syndrome in 1, and MOF in 1.There was one mortality because of MOF in the early postoperative period. Five survivors were followed up from 6 months to 5 5 years (mean 2 3 years). There was no late mortality and only one patient had mild left atrioventricular valve regurgitation. NYHA cardiac function was class I in 4 patients and class II in 1. Conclusions AVSD TOF can be corrected using the two patch technique and closure of the ventricular septal defect through a combined approach using a right ventriculotomy and right atriotomy. Routine closure of the commissure of the left portion of the atrioventricular valve results in a low incidence of regurgitation. Good functional result can be achieved in most patients postoperatively.