双向腔肺动脉分流术治疗婴幼儿复杂先心病

Application of bidirectional cavopulmonary artery shunt for complex congenital heart disease in children

目的总结双向腔肺动脉分流术治疗婴幼儿复杂先心病的效果。方法2001-01～2004-10对25例复杂先心病患者行双向腔肺动脉分流术,其中男14例,女11例;年龄37d至3岁,平均1.1±0.8岁;体重3.6～15kg,平均7.3±2.8kg;术前经皮血氧饱和度58.7%～78.5%,平均73.5%±5.8%,血细胞压积43.5%～72.8%,平均54.8%±9.9%。其中单心室9例,右室双出口5例,完全性大血管转位4例,肺动脉闭锁2例,Ebsteins畸形2例,三尖瓣及右室发育不良2例,三尖瓣闭锁1例。23例患者血流动力学特征为功能性单心室合并肺动脉狭窄。体外循环(CPB)完成手术15例,其中平行循环8例,心脏停跳下手术7例;非体外下循环下手术10例。单侧双向腔肺动脉分流术手术17例,双侧双向腔肺动脉分流术8例。Blalok-Taussig(B-T)分流术后二期手术3例。结果全组死亡1例,为1例DORV患者术后10d喂奶时误吸导致呼吸衰竭死亡。24例生存者随访3月至3.5年,发绀均明显改善,经皮血氧饱和度较术前均明显增高,二维或实时三维多普勒超声检查均未发现上腔静脉回流梗阻。结论根据患者病情选择体外循环或非体外循环下实施双向腔肺动脉分流术治疗婴幼儿肺少血型复杂先心病,是可行的,效果是满意的。

Objective To summarize the clinical effect of the bidirectional cavopulmonary artery shunt on complex congenital heart disease in children.Methods The 25 patients underwent bidirectional cavopulmonary artery shunt from Jan. 2001 to Oct.2004.Among the 25 patients there were 14 male and 11 female, aged from 37 days to 3 years(mean 1.1±0.8years), weighted from 3.6-15.0kg(mean7.3±2.8kg). The mean transcutaneous oxygen saturation was 73.5%±5.8%, mean hematocrit was 54.8±9.9% before operation; of 25 cases 9 with single ventricle, 5 with DORV, 4 with transposition of great arteries, 2 with pulmonary atresia, 2 with Ebstein's anomaly, 2 with hypoplasia of tricuspid and right ventricle and 1 with tricuspid atresia; The hemodynamic feature of 23 cases was a functional single ventricle with pulmonary arterial stenosis. In 15 cases operations were performed with CPB,among them in 8 with parallel CPB and 7 underwent clamping aorta; in other 10 cases operations were performed without CPB. Among them, 17 patients underwent single lateral bidirectional cavopulmonary artery shunt, 8 parients bilateral bidirectional cavopulmonary artery shunt. Also the 3 patients received secondary operation following B-T shunt. Result Of 25 cases 1 died before the operation, 24 survivors were followed-up from 3 months to 3.5 years, their symptom of cyanosis was improved remarkably and transcutaneous oxygen saturation was raised obviously; in their echocardiography no obstruction of superior vena cava was found.Conclusion With CPB or without CPB should be selected according to the patient's condition,and bidirectional cavopulmonary artery shunt for complex congenital heart disease in children with inadequate pulmonary blood flow is feasible, its response is satisfactory.