同种异体大血管移植治疗小儿复杂先天性心脏病

１９９０年８月至１９９３年４月，施行同种异体大血管移植治疗小儿复杂先天性心脏病５例，死亡１例．５例中男４例女１例，年龄４－８岁，平均体重１８Ｋｇ，均为复杂畸形，４例严重紫绀，１例轻度紫绀，病理改变主要在肺动脉系统，病种包括肺动脉闭锁、共同动脉干、右肺动脉起源异常、单心室、大动脉转位等，病种包括肺动脉闭锁、共同动脉干、右肺动脉起源异常、单心室、大动脉转位等．均在深低温低流量或深低温停循环下行根治手术，术式包括Ｒａｓｔｅｌｌｉ’ｓ、Ｆｏｎｔａｎ’ｓ和肺动脉重建．所用同种血管有带瓣主动脉、带瓣肺动脉及胸主动脉，术后４例恢复良好，无并发症，痊愈出院．１例因严重低心排、肾衰死亡．术后短期随访表明同种异体血管血液动力学良好，瓣膜功能正常，免疫指标正常，无明显排斥反应．

The Treatment of Complex Congenital Heart Diseases with Homografts in Children

Through August 1990 to 1993 homografts had been used in treating children's congenital heart diseases sucessfully in 5 cases.There were 4 males and 1 female,4～8 years old, average body weight 18kg.All the 5 cases were complex heart abnormalities,including pulmonary atresia,truncus arteriocus,abnormal origin of right pulmonary artery,single ventricle and TGA.Severe cyanosis was noted in 4 cases.The corrective operations were performed under deep hypothermia and low flow or circulatory arrest.The conduits used included aortic,pulmonary and thoracic descending aortic homogragts.(Four cases recovered satisfactorily without any complication.One case died from severe postoperative low output syndrome and renal failure.)One to four year follow-up showed good hemodynamic property and normal valvular function.