婴幼儿主动脉缩窄合并心内畸形的Ⅰ期手术纠治

目的:总结主动脉缩窄合并心内畸形的外科治疗经验。方法:回顾分析2007年1月至2011年6月我院收治的婴幼儿主动脉缩窄合并心内畸形Ⅰ期手术治疗的临床病例。共计42例,其中男性26例,女性16例。平均年龄(1.6±0.9)岁(6 d～3岁),平均体质量(7.2±2.5)kg(2.8～12kg)。主动脉缩窄合并心内畸形:37例合并室间隔缺损,5例合并房间隔缺损,7例同时合并主动脉瓣二瓣畸形,手术方法采用双切口I期纠治5例,正中切口I期纠治37例,其中锁骨下动脉翻转法(8例)、人工补片法(6例)、端端吻合法(15例)、端端吻合+补片法(13例)。结果:本组42例中,死亡1例,术后9 d死于肺部感染,病死率2.4%。术后均复查心脏彩超显示降主动脉血流通畅,无明显狭窄,3例提示降主动脉内仍存在20～40 mmHg(1 mmHg=0.133 kPa)压差,心脏彩超示吻合口处狭窄,血流速度增快。结论:婴幼儿主动脉缩窄合并心内畸形采用深低温选择性脑灌注方法经胸骨正中切口I期手术治疗可以达到满意疗效。彻底切除缩窄段及导管组织是手术成功的关键。

One-stage repair of coarctation of aorta in neonates and infants associated with cardiac anomalies

Objective: To summarize the clinical experience of one-stage repair of coarctation o f the aorta in neonates and infants associated with cardiac anomalies.Methods: There were 42 patients with coarctation of the aorta associated with cardiac anomalies were surgically repaired from January 2007 to June 2011.Patients age from 6 days to 3 years(1.6±0.9)years,with the mean body weight from(7.2 ±2.5) kg(2.8~12 kg).Coarctation of the aorta consisted of ventricle septal defect in 37 cases and atrial septal defect 5 cases.Patients were one-stage repaired through median sternotomy in 37cases,through two sternotomy in 5 cases.We perform the subclavian flap aortoplasty technique(8 cases),Prosthetic patch aortoplasty(6 cases),Resection with Extended End-to-End Anastomosis(15 cases),Resection with extended end-to-end anastomosis and patch aortoplasty(13 cases).Results: There were 1 in hospital deaths for pulmonary infection.Mortality is 2.4%.The echocardiography revealed no residual aortic arch obstruction.There were systolic pressure difference between arm and leg in 3 patients.The systolic pressure of upper limb was higher than that of lower limb in 6 patients and the pressure difference was 2.67 kpa to 5.32 kpa in 3patients.Conclusion: The short-term result of one-stage repair of coarctation of the aorta with selective antegrade cerebral perfusion in neonates and infants associated with cardiac anomalies was excellent.Completely resection is the key of operation.