法洛四联症伴冠状动脉畸形的外科治疗

目的：总结法洛四联症伴冠状动脉畸形手术治疗经验，探讨冠状动脉畸形在法洛四联症纠治手术中的意义。方法：自1994年1月至1999年12月，手术治疗法洛四联症伴冠状动脉畸形15例，年龄43d-8岁，其中右冠状动脉起源于左冠状动脉或左前降支6例，单支左冠状动脉和左前降支起源于右冠状动脉各3例。双前降支，单支右冠状动脉和右冠状动脉肺动脉瘘各1例。一期根治手术13例，姑息手术2例。结果：姑息手术无死亡，根治手术早期死亡1例；无冠状动脉手术意外损伤；随访结果满意。结论：根据肺血管条件和畸形冠状动脉走行特点，选择适当的手术方式和右室流出道重建方法可提高手术效果；冠状动脉畸形不再是法洛四联症纠治手术中的风险因素。

Surgical treatment of tetralogy of Fallot with anomalous coronary artery

Objective: This paper reported the experience of surgical treatment of tetralogy of Fallot with anomalous coronary artery. Methods: Fifteen patients of tetralogy of Fallot with anomalous coronary arteries underwent surgical correction from January 1994 to December 1999. The coronary artery abnormalities included right coronary artery originating from left coronary artery or left anterior decending coronary artery in 6, single left coronary artery in 3, left anterior decending coronary artery originating from right coronary artery in 3 bilateral anterior decending coronary artery originating from the left and right coronary artery in 1, single right coronary artery in 1, fistula between right coronary artery and pulmonary artery in 1. One stage correction was done in 13 cases and the other 2 cases underwent palliative procedure. Results: There was one postoperative death. There was no severe postoperative complications.The follow up results were satisfactory. Conclusion: Proper selection of surgical techniques according to condition of PA and course of anomalous coronary arterial may improve surgical outcome for patients with TOF/ACA. Pulmonary arteries and the courses of anomalous coronary arteries.