复杂性动脉导管未闭的外科治疗

Surgical treatment of complex patent ductus arterious

目的 :介绍复杂性动脉导管未闭 (PDA)诊断和手术治疗。方法 :采用胸骨正中切口。一期治疗PDA和心内伴发畸形。依据导管粗细 ,肺动脉扩张程度 ,采用结扎法和深低温低流量法经肺动脉缝闭PDA。要确认PDA周围的解剖 ,包括主动脉、左、右肺动脉 ,以免误扎。结果 :本组 72例 ,女性占6 7% ;PDA直径 0 3～ 1 8cm。伴发心内畸形中以室间隔缺损为主占 6 0 % ,法洛四联症 18%。死亡 1例 ,系合并室间隔缺损伴主动脉弓离断 ,误扎生命依赖导管。结论 :一期治疗PDA及伴发的心内畸形 ,避免二次手术的损伤 ,为安全、有效的治疗方法。及时发现恰当处理PDA ,决定治疗的结果 ,需特别引起重视。

Objective: To introduce the diagnosis,peri-operative treatment,and operating procedure of the complex patent ductus arterious(PDA). Method: The ductus is approached via a median sternotomy.It is occluded before the cross-clamping of the aorta,then the intracardiac portion of the operation is proceeded.The moderate-sized ductus(less than 1.5 cm)is undergone direct ligation and the large ductus(over 1.5 cm)with hypertension of pulmonary artery,is closed through a longitudinal pulmonary artery incision with a Dacron patch.The deep hypothermic circulatory arrest and low-flow bypass is employed in the latter situation.Result:From 1988 to 2001,72 patients(48 women,24 men)with complex PDA were operated.The ductus in 70 cases arises from the proximal portion of the left pulmonary artery and connects to the descending aorta,but in 2 cases,from main pulmonary artery to ascending aorta.The associated intracardiac lesions include ventricular septal defect(42 cases),Tetralogy of Fallot(13 cases),Atrial septal defect(8 cases),Atrial septal defect with ventricular septal defect(6 cases),ventricular septal defect with interrupted aortic arch(1 case),and mitral stenosis (1 case).Early death in 1 patient with interrupted aortic arch,the compensatory ductus arterious is ligated.71 patients with a good recovery in a period of 6 months to 10 years fellow-up.Conclusion:Simultaneous operations on patients with complex PDA are safety and efficiency.During this procedure,potential compromise of the left pulmonary artery must be kept in mind.Care must also be taken that the ligature does not impinge on the aortic isthmus or distal aortic arch.