中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2011年
5期
264-266,270
,共4页
莫绪明%顾海涛%左维嵩%孙剑%彭卫%戚继荣%沈立%丁君%武开宏%夏建海%王振喜%钱龙宝
莫緒明%顧海濤%左維嵩%孫劍%彭衛%慼繼榮%瀋立%丁君%武開宏%夏建海%王振喜%錢龍寶
막서명%고해도%좌유숭%손검%팽위%척계영%침립%정군%무개굉%하건해%왕진희%전룡보
室间隔缺损,肌部%镶嵌治疗%封堵器%儿童
室間隔缺損,肌部%鑲嵌治療%封堵器%兒童
실간격결손,기부%양감치료%봉도기%인동
Muscular ventricular septal defect Hybrid procedure Occluder Cardiopulmonary bypass Children
目的 探讨镶嵌模式(hybrid procedure)治疗小儿肌部室间隔缺损(Mvsd)的手术方法及临床应用.方法 2006年1月至2010年6月,在体外循环心内直视手术下采用手术及封堵相结合的镶嵌技术矫治小儿Mvsd 45例,其中男20例,女25例;年龄52天～12岁;体重3～32 kg.7例为单个Mvsd,38例为多发性VSD.同时合并大血管错位(D-TGA)1例、法洛四联症(TOF)2例、肺动脉狭窄(PS)3例、动脉导管未闭(PDA)6例、房间隔缺损(ASD)6例、主动脉缩窄1例.均在心脏停跳后直视下将导引钢丝经三尖瓣孔自心脏右室面穿过VSD至左室面,直视下置入导引器,然后送入封堵器,完成Mvsd封堵.多发性VSD 38例,予自体心包片修补膜周部等较大的VSD,心内其他畸形同期完成矫治.结果 42例置入单枚封堵器(直径4～10 mm)、3例置入双枚封堵器(直径4～7 mm).手术经过顺利,术前左室射血分数(EF)均在正常范围,术后1天小于8月龄组EF均值低于正常,大于8月龄组EF正常,两者差异有统计学意义.术后常规每天给予5 mg/kg肠溶阿司匹林3～6个月.术后随访超声检查示封堵器位置无偏移,无残余分流,无二尖瓣、主动脉瓣反流、Ⅲ度传导阻滞及新发心律失常等.术后因重症感染放弃治疗1例,无远期死亡病例.结论 体外循环下镶嵌技术治疗小儿 Mvsd明显降低了围手术期并发症及病死率,简化了手术过程,降低了手术风险,是一种安全、有效的方法.
目的 探討鑲嵌模式(hybrid procedure)治療小兒肌部室間隔缺損(Mvsd)的手術方法及臨床應用.方法 2006年1月至2010年6月,在體外循環心內直視手術下採用手術及封堵相結閤的鑲嵌技術矯治小兒Mvsd 45例,其中男20例,女25例;年齡52天～12歲;體重3～32 kg.7例為單箇Mvsd,38例為多髮性VSD.同時閤併大血管錯位(D-TGA)1例、法洛四聯癥(TOF)2例、肺動脈狹窄(PS)3例、動脈導管未閉(PDA)6例、房間隔缺損(ASD)6例、主動脈縮窄1例.均在心髒停跳後直視下將導引鋼絲經三尖瓣孔自心髒右室麵穿過VSD至左室麵,直視下置入導引器,然後送入封堵器,完成Mvsd封堵.多髮性VSD 38例,予自體心包片脩補膜週部等較大的VSD,心內其他畸形同期完成矯治.結果 42例置入單枚封堵器(直徑4～10 mm)、3例置入雙枚封堵器(直徑4～7 mm).手術經過順利,術前左室射血分數(EF)均在正常範圍,術後1天小于8月齡組EF均值低于正常,大于8月齡組EF正常,兩者差異有統計學意義.術後常規每天給予5 mg/kg腸溶阿司匹林3～6箇月.術後隨訪超聲檢查示封堵器位置無偏移,無殘餘分流,無二尖瓣、主動脈瓣反流、Ⅲ度傳導阻滯及新髮心律失常等.術後因重癥感染放棄治療1例,無遠期死亡病例.結論 體外循環下鑲嵌技術治療小兒 Mvsd明顯降低瞭圍手術期併髮癥及病死率,簡化瞭手術過程,降低瞭手術風險,是一種安全、有效的方法.
목적 탐토양감모식(hybrid procedure)치료소인기부실간격결손(Mvsd)적수술방법급림상응용.방법 2006년1월지2010년6월,재체외순배심내직시수술하채용수술급봉도상결합적양감기술교치소인Mvsd 45례,기중남20례,녀25례;년령52천～12세;체중3～32 kg.7례위단개Mvsd,38례위다발성VSD.동시합병대혈관착위(D-TGA)1례、법락사련증(TOF)2례、폐동맥협착(PS)3례、동맥도관미폐(PDA)6례、방간격결손(ASD)6례、주동맥축착1례.균재심장정도후직시하장도인강사경삼첨판공자심장우실면천과VSD지좌실면,직시하치입도인기,연후송입봉도기,완성Mvsd봉도.다발성VSD 38례,여자체심포편수보막주부등교대적VSD,심내기타기형동기완성교치.결과 42례치입단매봉도기(직경4～10 mm)、3례치입쌍매봉도기(직경4～7 mm).수술경과순리,술전좌실사혈분수(EF)균재정상범위,술후1천소우8월령조EF균치저우정상,대우8월령조EF정상,량자차이유통계학의의.술후상규매천급여5 mg/kg장용아사필림3～6개월.술후수방초성검사시봉도기위치무편이,무잔여분류,무이첨판、주동맥판반류、Ⅲ도전도조체급신발심률실상등.술후인중증감염방기치료1례,무원기사망병례.결론 체외순배하양감기술치료소인 Mvsd명현강저료위수술기병발증급병사솔,간화료수술과정,강저료수술풍험,시일충안전、유효적방법.
Objective To summarize the technique and clinical experience of hybrid procedure under cardiopulmonary bypass (CPB) in children with muscular ventricular septal defect (mVSD). Methods From January 2006 to June 2010, 45 cases of mVSD underwent hybrid procedure with CPB. mVSDs were closed with devices under direct vision in 45 cases. Of them, there were 20 males and 25 females. They ranged from 52 days to 12 years [mean (2.05 ±2.48) year] in age and from 3 to 30 kg [(11.93 ±7.70)kg] in body weight. Preoperatively, most of children were highly susceptible to respiratory tract infections. The hybrid approach was used in all patients with CPB under the guidance of transesophageal echocardiography (TEE). The diameter of mVSDs ranged from 2 to 7 mm under TEE. Of 45 cases, 40 patients had increased rates of pulmonary blood flow. 29 patients had left axis deviation and 12 cases had sinus arrhythmia on electrocardiography (ECG). 19 had other congenital heart lesions, including transposition of great arteries in 1 case, tetralogy of Fallot in 2, pulmonary artery stenosis in 3, patent ductus arteriosus in 6, atrial septal defects in 6) and aorta coactation in 1. The quantity of VSDs were from 1 to 7 (single, in 7; two, in 24 case; three, in 8 case; four, in 5 case and seven, in lease. 37 patients were combined with pulmonary hypertension in our cohort. 38 patients with another large VSD and 19 with other congenital heart lesions were required surgical repair at sometime. Results The hybrid procedures were undertaken in all 45 cases of this cohort. All cases were successful and no deaths occurred during operation. A total of 48 devices were implanted in 45 patients, including single devices in 42 cases (device size ranged from 4 to 10 mm) and two devices in 3 cases (device size ranged from 4 -7 mm). The average time on CPB was (58.28 ±20.70) min , while aortic crossclamp time was(34. 94 ± 14.75) min. In addition, the time on mechanical ventilation postoperatively ranged from 2 hours to 6 days. Compared to the older children, 20 infante aged less than 8 monhad a significant difference in cardiac function in the early postoperative period. One infant was given up treatment because of serious infection. Anather cases recovered with the use of supportive treatment, such as using vasoactive agents, digoxin, inhaling nitric oxide, diuresis, and so on. The enteric-coated aspirin was given at dose of 5 mg ? kg -1. day -1 for a period of 3 to 6 months as usual postoperatively. All patients attended follow-up at 1 week, 1 month, 3 months, 6 months, 1 year and 2 years post-procedure. No major complications were encountered during this period. All cases were no instance of migration of any of the devices, residual shunt, aortic regurgitation, atrioventricular valve dysfunction, Ⅲo atrial-ventricular conduction block, new arrhythmia, and so on. There are no death in long-term follow-up. Conclusion Hybrid procedure is safe and effective for the closure of congenital heart defects in children.
