体外循环心脏停跳和不停跳下动脉导管闭合术

Closure of patent ductus arteriosus with or without beating heart under cardiopulmonary bypass

目的 提高体外循环心脏停跳和不停跳下动脉导管未闭 ( patentductusarteriosus ,PDA)的外科治疗水平。方法 2 7例PDA患者 ,导管直径 0 .4～ 2 .8cm。均在体外循环下经肺动脉切口行PDA内口缝闭术。 9例采用深低温低流量 ,10例采用低温 ,8例采用浅低温心脏不停跳。对合并心内畸形同期矫正。结果 1例术后出现低心排血量综合征 ,经药物治疗纠正。 1例术后出现声音嘶哑 ,4周后恢复。全组病例术后心脏杂音消失 ,无导管再通或残余分流 ,无死亡 ,均康复出院。结论 对PDA合并重度肺动脉高压和PDA合并其他心内畸形需同期矫正等复杂病例 ,在体外循环心脏停跳和不停跳下 。

Objective To introduce the experiences of surgical treatment on patent ductus arteriosus (PDA) with or without beating heart under cardiopulmonary bypass.Methods All 27 PDA patients whose ductus were from 0.4 to 2.8 cm,were subjected to suturing closure of the PDA opening through pulmonary artery cut under cardiopulmonary bypass.Of them,9 PDA patients underwent deep hypothermia and low perfusion flow,10 PDA patients hypothermia and 8 PDA patients mild hypothermia on beating heart.The complicated intra-cardiac malformation was repaired simultaneously.Results Only in 1 case of PDA,low cardiac output syndrome developed after operation,which was cured by drug therapy.Only in 1 case of PDA,hoarseness developed and recovered 4 weeks later.All patients recovered well without cardiac murmur,ductus re-opening and residual shunt.Conclusion To the complicated cases of PDA complicated with severe pulmonary hypertension or with other intra-cardiac malformation which needs to be repair simultaneously,satisfactory results can be obtained by suturing closure of the PDA intra-opening by way of pulmonary artery cut under cardiopulmonary bypass with or without beating heart (especially with beating heart).