CAJ | 학술논문

目的探讨小儿主动脉瓣下狭窄(subvalvular aortic stenosis,SAS)的外科治疗方法并观察其治疗效果.方法统计1990年1月至2010年12月我院收治并进行手术治疗的22例SAS,男15例,女7例,年龄8个月至15岁,平均(5.93±3.90)岁.随访时间1个月至13.5年,平均(7.30±5.60)年.22例中单纯SAS 5例,合并其他心内畸形为:室间隔缺损16例,右室双腔2例,动脉导管未闭2例.22例患儿全部进行外科手术治疗,行单纯隔膜状狭窄或肌纤维环切除术18例,加左室肥厚心肌切除术3例.1例合并动脉导管未闭患儿先经左胸行动脉导管结扎术,随访6年后再次手术行单纯隔膜狭窄切除术.结果所有患儿手术顺利,22例中治愈19例(86.36％),复发3例(13.64％),无死亡病例.治愈病例中,临床症状均消失,经超声心动图检查,均未见主动脉瓣下狭窄复发,无左室到主动脉收缩期压力阶差.3例复发患儿随访时间分别为4年、10年、12年.结论小儿主动脉瓣下狭窄的外科治疗关键是彻底解除左室流出道梗阻,避免二尖瓣、主动脉瓣及传导束损伤.术中梗阻解除不彻底以及术后局部组织过度生长可能是SAS术后复发的重要因素.
목적 탐토소인주동맥판하협착(subvalvular aortic stenosis,SAS)적외과치료방법병관찰기치료효과.방법 통계1990년1월지2010년12월아원수치병진행수술치료적22례SAS,남15례,녀7례,년령8개월지15세,평균(5.93±3.90)세.수방시간1개월지13.5년,평균(7.30±5.60)년.22례중단순SAS 5례,합병기타심내기형위:실간격결손16례,우실쌍강2례,동맥도관미폐2례.22례환인전부진행외과수술치료,행단순격막상협착혹기섬유배절제술18례,가좌실비후심기절제술3례.1례합병동맥도관미폐환인선경좌흉행동맥도관결찰술,수방6년후재차수술행단순격막협착절제술.결과 소유환인수술순리,22례중치유19례(86.36％),복발3례(13.64％),무사망병례.치유병례중,림상증상균소실,경초성심동도검사,균미견주동맥판하협착복발,무좌실도주동맥수축기압력계차.3례복발환인수방시간분별위4년、10년、12년.결론 소인주동맥판하협착적외과치료관건시철저해제좌실류출도경조,피면이첨판、주동맥판급전도속손상.술중경조해제불철저이급술후국부조직과도생장가능시SAS술후복발적중요인소.
Objective To study the results of surgical treatment on subvalvular aortic stenosis (SAS) in children.Methods 22 cases of SAS were included from January 1990 to December 2010.There were 15 males and 7 females.The age range was from 8 months to 15 years (mean 5.93 ± 3.90years),and the follow-up period ranged from 1 month to 13.5 years (mean 7.30 ± 5.60 years).Overall,simple SAS were seen in 5 cases,while the others had other associated cardiac malformations:ventricular septal defect (VSD) in 16 cases,dual-chamber right ventricle in 2 cases,patent ductus arteriosus (PDA) in 2 cases.All children underwent surgical treatment.Simple annular diaphragm-like stenosis or muscle resection were done in 18 cases; left ventricular hypertrophy myocardial resection done in 3 cases; 1 patient with PDA had ligation first,and followed by surgical resection of simple diaphragm-like stenosis after 6 years.Results Successful surgery was carried out in all.19 patients were cured (86.36％ ) with recurrence seen in 3 cases ( 13.64％ ).There was no surgical mortality.Post-operative echocardiography showed no systolic pressure gradient from left ventricle to aorta in the successful cases.For the 3 cases of recurrence,they were followed up for 4 years,10 years,12 years,respectively.Conclusions The key to successful surgical treatment on subvalvular aortic stenosis in children is complete removing of the stenosis of left ventricular outflow tract obstruction,and to avoid damage to the mitral valve,aortic valve and conduction bundle.Incomplete removal of stenosis and postoperative local tissue overgrowth may be important factors in SAS recurrence.