中国循环杂志
中國循環雜誌
중국순배잡지
CHINESE CIRCULATION JOURNAL
2014年
6期
458-460
,共3页
王显悦%毕生辉%童光%董文鹏%王晓武%梁爱琼%徐宇%张卫达
王顯悅%畢生輝%童光%董文鵬%王曉武%樑愛瓊%徐宇%張衛達
왕현열%필생휘%동광%동문붕%왕효무%량애경%서우%장위체
主动脉缩窄%主动脉弓发育不良%选择性脑灌注
主動脈縮窄%主動脈弓髮育不良%選擇性腦灌註
주동맥축착%주동맥궁발육불량%선택성뇌관주
Coarctation of the aorta%Aortic arch hypoplasia%Selective cerebral perfusion
目的:观察自体肺动脉补片一期矫治主动脉缩窄(COA)伴主动脉弓发育不良的手术效果。
<br> 方法:自2009-05至2013-05于我中心就诊的COA伴主动脉弓发育不良患儿22例,均经心脏计算机断层摄影术血管造影(CTA)明确诊断。所有患儿均行肺动脉补片一期矫治主动脉缩窄伴主动脉弓发育不良,主动脉弓部操作时给予选择性低流量脑灌注,同期矫治心内畸形。
<br> 结果:全组患儿无围术期死亡。6例患儿手术操作完成时上肢压力高于下肢,压力阶差小于30 mmHg(1 mmHg=0.133 kPa),术后压力阶差逐渐减少,至转出监护室时2例患儿上肢压力仍高于下肢,压力阶差小于15 mmHg;其余16例患儿下肢压力均高于上肢。全组患儿无脑部并发症。2例患儿存在高血压,口服药物治疗;术后患儿右上肢血压(105±16)mmHg,左上肢血压(107±19)mmHg,下肢血压(113±20)mmHg。全组随访2~50个月,所有患儿经心脏彩超检查心内畸形和主动脉病变矫治理想,8例复查心脏CTA,主动脉形态良好。
<br> 结论:自体肺动脉补片一期矫治主动脉缩窄伴弓发育不良,病变解除良好,并发症少,手术后早中期效果理想。
目的:觀察自體肺動脈補片一期矯治主動脈縮窄(COA)伴主動脈弓髮育不良的手術效果。
<br> 方法:自2009-05至2013-05于我中心就診的COA伴主動脈弓髮育不良患兒22例,均經心髒計算機斷層攝影術血管造影(CTA)明確診斷。所有患兒均行肺動脈補片一期矯治主動脈縮窄伴主動脈弓髮育不良,主動脈弓部操作時給予選擇性低流量腦灌註,同期矯治心內畸形。
<br> 結果:全組患兒無圍術期死亡。6例患兒手術操作完成時上肢壓力高于下肢,壓力階差小于30 mmHg(1 mmHg=0.133 kPa),術後壓力階差逐漸減少,至轉齣鑑護室時2例患兒上肢壓力仍高于下肢,壓力階差小于15 mmHg;其餘16例患兒下肢壓力均高于上肢。全組患兒無腦部併髮癥。2例患兒存在高血壓,口服藥物治療;術後患兒右上肢血壓(105±16)mmHg,左上肢血壓(107±19)mmHg,下肢血壓(113±20)mmHg。全組隨訪2~50箇月,所有患兒經心髒綵超檢查心內畸形和主動脈病變矯治理想,8例複查心髒CTA,主動脈形態良好。
<br> 結論:自體肺動脈補片一期矯治主動脈縮窄伴弓髮育不良,病變解除良好,併髮癥少,手術後早中期效果理想。
목적:관찰자체폐동맥보편일기교치주동맥축착(COA)반주동맥궁발육불량적수술효과。
<br> 방법:자2009-05지2013-05우아중심취진적COA반주동맥궁발육불량환인22례,균경심장계산궤단층섭영술혈관조영(CTA)명학진단。소유환인균행폐동맥보편일기교치주동맥축착반주동맥궁발육불량,주동맥궁부조작시급여선택성저류량뇌관주,동기교치심내기형。
<br> 결과:전조환인무위술기사망。6례환인수술조작완성시상지압력고우하지,압력계차소우30 mmHg(1 mmHg=0.133 kPa),술후압력계차축점감소,지전출감호실시2례환인상지압력잉고우하지,압력계차소우15 mmHg;기여16례환인하지압력균고우상지。전조환인무뇌부병발증。2례환인존재고혈압,구복약물치료;술후환인우상지혈압(105±16)mmHg,좌상지혈압(107±19)mmHg,하지혈압(113±20)mmHg。전조수방2~50개월,소유환인경심장채초검사심내기형화주동맥병변교치이상,8례복사심장CTA,주동맥형태량호。
<br> 결론:자체폐동맥보편일기교치주동맥축착반궁발육불량,병변해제량호,병발증소,수술후조중기효과이상。
Objective: To observe the outcomes of one-stage surgical correction of aortic coarctation (COA) complicated with aortic arch hypoplasia by autologous pulmonary artery patch.
<br> Methods: A total of 22 COA with aortic arch hypolasia children treated in our hospital from 2009-05 to 2013-05 were summarized. All patients were clearly diagnosed by CTA. All patients received the one-stage surgical correction of aortic coarctation complicated with aortic arch hypoplasia by autologous pulmonary artery patch. The selective low-lfow cerebral perfusion was used during aortic arch procedure and the concomitant cardiac anomalies were corrected during the same surgery.
<br> Results: No peri-operative death. There were 6 patients with the upper arm BP higher than lower arm immediately after the operation and the pressure gradient <30 mmHg, the pressure gradient decreased gradually and 2 patients with the upper arm BP higher than lower arm until out of CCU and the pressure gradient <15 mmHg; the rest 16 patients with the lower arm BP higher than upper arm. No cerebral complication was observed. 2 patients suffered from high blood pressure and received medication. The postoperative right upper arm BP was at (105±16) mmHg, left upper arm BP was at (107±19) mmHg and the lower arm BP was at (113±20) mmHg. The patients were followed-up for (2-50) months. Color echocardiography demonstrated that the correction of intra-cardiac and aortic anomaly were ideal in all patients. Postoperative CTA was performed in 8 patients which showed the excellent aortic morphology.
<br> Conclusion: COA with aortic arch hypoplasia could be treated with one-stage surgical correction using autologous pulmonary artery patch, which had good early and mid term outcomes.