成人室间隔缺损的外科治疗

目的：报告成人室间隔缺损的外科治疗经验。方法：对26例成人室间隔缺损的手术治疗进行回顾性分析。其中行室缺直接缝合3例，单纯补片修补19例，单向活瓣补片修补4例。同时行主动脉瓣折叠悬吊2例，双瓣置换l例，二尖瓣成成形l例，三尖瓣成形4例．结果：无手术死亡。术后并发症：切口感染、术后出血二次开胸止血、呼吸道感染和片周漏各l例，心动过速4例．术后随访24例(92．3％)，随访时间1月～92月，晚期死亡l例，死因为片周漏并感染性心内膜炎．结论：成人室间隔缺损的临床表现虽较为复杂，手术效果令人满意．选择正确的手术方法及注意围术期处理是手术治疗成功的关键。

SURGICAL TREATMENT OF VENTRICULAR SEPTAL DEFECT IN ADULT.

Objective :To analyze and summarize the experiences of surgical treatment of VSD in adults.Method:From July 1990 to July 1999,surgical repairs were performed in 26 adult patients with VSD.Surgical procedures were direct closure of VSD in 3 patients,simple patch closure in 19 and one-way valved patch closure in 4.Combined operations included resection of R VOT in 2 patients,resection and repairment of valsalval aneurysm in 1 patient,DVR in 1 patient,mitral,aortic and tricuspid valvuloplasty in 1,2 and 4 patients respetively.Results:There was no perioperative mortality.The main postoperative complications were tachycardia in 4 cases,incison infection,hemorrhage needed rethoracotorny,residual shunt of VSD and infetion of respiratory tract in 1 case respetively.24 patients were follow-up from 1 to 92 months.There was one late death.The cause of death was infective endocarditise.Conclusion:Although the treatments of VSD in adults are relatively complicated,the operative results are satisfatory.The choice of operative way and perioperative managements are the tow importance factors influencing surgical outcome.