30例小儿完全型房室通道畸形的外科根治术

近30年中,我院对30例小儿完全型房室通道畸形做了外科根治术。手术采用单片法16例,双片法14例,合并其它心血管畸形做相应处理。住院死亡率36.7%,近5年为15.4%。随诊16例,效果优良率为75%。本文着重讨论了手术方法及影响疗效的因素。

COMPLETE REPAIR OF ATRIOVENTRICULAR SEPTAL DEFECT IN CHILDREN(30 CASES)

From Februray 1963 to July 1990, 30 consecutive cases with mean age of 6, 3 yr. receivd complete repair of atrioventricular septal defect, the pathological type of which was all Rastelli A. Repair was performed with single-patch technique on 16 cases, with twopatch technique on 14. Complicating abnormalities in 11 cases (such as tetralogy of Fallot and so on) underwent surgical procedures also except 1 cor triatriaturn. Hospital mortality was 36.7% (11/30), twopatch 50% (7/14) versus single-patch 25% (4/16). But in the recent 5 years it was decreased to 15.4% (2/13). There was no death in the last 9 consecutive patients who had no complicating abnormalities. Follow-up of 16 cases, ranged from 1 to 174 months, revealed good in 75%. We concluded that (1) singlepatch technique was better than two-patch in our series, good outcome can also be resulted from proper practice of the latter. The key point is precise reconstruction of the functional integrity of mitral valve; (2) the main complication of unsatisfactory repair in the early postoperative period is left ventricular outflow tract obstruction, so it is important to know the cause and management.