小儿三房心的外科治疗

SURGICAL TREATMENT OF COR TRIATRIATUM IN CHILDREN

我院自１９８３年１月至１９９２年３月间共手术治疗小儿三房心２２例。其中完全型１５例，部分型７例。手术均在低温体外循环下进行。术后死亡１例，其余均痊愈出院。本文着重讨论了本病的诊断、鉴别及手术要点。

A total of 22 cases of cor triatriatum with an average age of 7. 46 years underwent surgical treatment from January 1983 to March 1992 in Fu Wai Hospital ,among them 15 cases were true cor triatriatum, the others were atypical. They constituted only 0-31% of the surgical cases of congenital heart disease at the same period. The main associated anomalies were atrial septal defect in 16 cases and others such as ventricular septal defect, left superior vena cava etc. in 9. Cyanosis in 7 cases, squatting in 4. 18 were diagnosed by echocardiography preoperatively and 4 were identified during operation. Operations were performed with cardiopulmonary bypass under moderate hypothermia. Abnormal diaphragm in the left atrium was completely excised and other associated anomalies were also corrected, the early results were good except one postoperative death. The authors experienced: ①For the diagnosis of cor triatriatum preoperatively, the finding of abnormal diaphragm image in the left atrium by echocardiography is helpful and further invasive examination is not needed. Routine examination of the left atrium is necessary during atrial septal defect correction as cor triatriatum is of ten misdiagnosed as atrial septal defect. ②Cor triatriatum with small restrictive aperture in the diaphragm and early severe symptoms is strongly indicated for early surgical treatment. ③The technique of surgery is not difficult and good exposure of the abnormal diaphragm would help to prevent important adjacent structures from injury. The margin of excision of the diaphragm should be finely sutured to prevent late myocardial rupture. Myocardial protection during and after operation should be emphasized due to the small left ventricle.