成人先天性心脏病合并冠心病的外科治疗

目的探讨年龄>40岁的先天性心脏病合并冠心病手术治疗的安全性和有效性。方法 2002年2月～2009年5月,26例先天性心脏病(房间隔缺损18例,室间隔缺损4例,房室管畸形3例,三心房1例)合并冠心病(冠状动脉造影显示:单支病变10例,双支病变9例,三支病变7例)接受心脏畸形矫治联合冠状动脉搭桥手术,22例体外循环下行心脏畸形矫治和冠状动脉搭桥术,4例食管超声引导下行房间隔缺损术中伞堵(intraoperative device closure,IODC)及非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass,OPCAB)。冠状动脉旁路移植共完成46处远端吻合,同期行二尖瓣置换术2例,二尖瓣成形术3例,三尖瓣成形术5例,房颤射频消融术2例。结果 1例房室管畸形因肺部感染和多器官衰竭死亡,其余25例康复出院,无手术并发症。术后随访17～105个月,(57.6±24.7)月:1例术后18个月再发心绞痛,未接受再次医疗干预;术后患者心功能和肺动脉高压情况改善;4例杂交手术随访中未发现残余分流、血栓和封堵装置移位等并发症。结论外科治疗成人先天性心脏病合并冠心病效果良好。IODC联合OPCAB治疗房间隔缺损安全、有效。

Surgical Treatment for Congenital Heart Disease Complicated with Coronary Artery Disease in Adults

Objective To investigate the safety and efficacy of surgical treatment for adult patients with congenital heart disease(CHD) complicated with coronary artery disease(CAD).Methods From February 2002 to May 2009,26 adult patients with CHD(including 18 cases of atrial septal defect,4 cases of ventricular septal defect,3 cases of atrioventricular septal defect,and 1 case of cor triatriatum),who were complicated with CAD(coronary angiography demonstrated single-vessel CAD in 10 cases,two vessels in 9,and three vessels in 7),received surgical treatment in our hospital.We performed intracadiac correction of CAD and cardio-pulmonary bypass(CAB) with coronary revascularization in 22 of the patients,and intraoperative device closure(IODC) of ASD plus off-pump CAB(OPCAB) under the guidance by esophageal ultrasonography in the other 4 cases.With coronary artery bypass grafting,we completed distal anastomosis in 46 vessels;meanwhile,mitral valve replacement was performed on two patients,mitral valve plasty was carried out in three patients,tricuspid valve plasty in 5,and radiofrequency ablation for atrial fibrillation in 2.Results One patient,who had atrioventricular septal defect,died of pulmonary infection and multi-organ failure in 18 days after the operation.The other 25 patients recovered without showing surgical complications.They were followed up for 17 to 105 months with a mean of(57.6±24.7) months,during which,one patient developed angina in 18 months after the operation,and thus received a second intervention.All the patients showed improved cardiac function and relieved pulmonary hypertension;none of the 4 patients,who had received IODC plus OPCAB,had residual bypass flow,thrombus,or displacement of the occlusive device.ConclusionsSurgical treatment is a good option for adult patients with CHD complicated with CAD with good mid-term outcomes.IODC plus OPCAB is safe and effective for atrial septal defect.