CAJ | 학술논문

目的探讨婴幼儿主动脉缩窄合并心内畸形的外科治疗经验.方法 2000年1月至2006年12月,84例主动脉缩窄合并心内畸形患儿接受了外科手术治疗,手术年龄1个月～3岁(平均13.5个月),体重3.3～15.0 kg(平均7.3 kg).12例合并复杂心内畸形,72例合并室间隔缺损和其他简单心内畸形,23例伴有主动脉弓发育不良.一期手术62例,49例正中开胸同时矫治主动脉缩窄和心内畸形,13例左侧开胸矫治主动脉缩窄,正中开胸修补心内畸形;分期手术22例.主动脉缩窄的手术方式包括补片成形42例,切除端端吻合30例,锁骨下动脉翻转6例,血管旁路3例,球囊扩张1例.在49例正中切口一期手术中,43例应用选择性脑灌注加下半身停循环,4例应用全身低流量灌注,2例应用深低温停循环.结果围手术期死亡8例,死亡率9.5%,其中3例为术前漏诊主动脉缩窄.结论婴幼儿主动脉缩窄合并心内畸形的外科治疗可获得良好的近期疗效,绝大部分患儿可采取正中切口一期手术.选择性脑灌注和下半身停循环可以有效地保护脑和重要脏器.
목적 탐토영유인주동맥축착합병심내기형적외과치료경험.방법 2000년1월지2006년12월,84례주동맥축착합병심내기형환인접수료외과수술치료,수술년령1개월～3세(평균13.5개월),체중3.3～15.0 kg(평균7.3 kg).12례합병복잡심내기형,72례합병실간격결손화기타간단심내기형,23례반유주동맥궁발육불량.일기수술62례,49례정중개흉동시교치주동맥축착화심내기형,13례좌측개흉교치주동맥축착,정중개흉수보심내기형;분기수술22례.주동맥축착적수술방식포괄보편성형42례,절제단단문합30례,쇄골하동맥번전6례,혈관방로3례,구낭확장1례.재49례정중절구일기수술중,43례응용선택성뇌관주가하반신정순배,4례응용전신저류량관주,2례응용심저온정순배.결과 위수술기사망8례,사망솔9.5%,기중3례위술전루진주동맥축착.결론 영유인주동맥축착합병심내기형적외과치료가획득량호적근기료효,절대부분환인가채취정중절구일기수술.선택성뇌관주화하반신정순배가이유효지보호뇌화중요장기.
Objective To review the experience in repair of aortic coarctation with intracardiac anomaly in infants and toddlers.nethods From January 2000 to December 2006,84 infants and children diagnosed as aortic coarctation with intracardiac anomaly underwent surgical treatment.Mean age of the patients was 13.5 months,with a range from 1 month to 3 years.Mean body weight was 7.3 kg,with a range from 3.3 to 15 kg.Twelve patients complicated with complex intracardiac anomaly.Seventy-two patients complicated with ventricular septal defect and other simple anomaly.Twenty-one patients had hypoplasia of the aortic arch.Sixty-two patients had one-stage repair.Median sternotomy was used to simultaneously repair coarctation and intracardiac defect in 49 patients.Left thoracotomy and median sternotomy were applied to repair aortic coarctation and intracardiac anomaly respectively in 13 patients.Twenty-two patients had staged repair.Operational techniques for aortic coarctation include 42 patients of patch aortoplasty,30 patients of resection and end-to-end anastomosis,6 patients of subclavian flap aortoplasty,3 patients of vascular bypass,and 1 patient of balloon dilation.In all 49 patients of one-stage operation through median sternotomy,selective cerebral perfusion was used in 43 patients,deep hypothermia low flow was applied in 4 patients,deep hypothermia circulatory arrest was performed in 2 patients.Results There were 8 hospital deaths.The mortality is 9.5%.Among 8 deaths,3 patients were misdiagnosed.Conclusions Surgeries for aortic coarctation with intracardiac anomaly have satisfactory short-term results in infants and toddlers.Onestage repair through median stemotomy can be applied to most of the patients.Selective cerebral perfusion with deep hypothermia and circulatory arrest in lower body can protect the brain and other vital organs.