采用同期手术矫治主动脉缩窄合并心内畸形疗效分析

One-stage correction of coarctation of aorta with intracardiac anomalies

目的 探讨同期手术治疗主动脉缩窄合并心内畸形的治疗效果。方法 本组12例,诊断主动脉缩窄合并动脉导管未闭及室间隔缺损7例,合并动脉导管未闭及房间隔缺损4例,合并动脉导管未闭及部分房室间隔缺损1例,主动脉缩窄均为峡部,同时伴严重肺动脉高压。其中,同期先在全身静脉麻醉,全身低温(3 4℃)左胸后外侧切口下手术切除缝扎动脉导管,切除缩窄段主动脉行端端吻合,再在正中切口行心内畸形矫治手术10例;2例分别在正中切口行心内畸形矫治手术中及术后发现合并主动脉缩窄,关闭正中切口后,在全麻全身低温(3 4℃)左胸后外侧切口下,切除缩窄段,行端端吻合重建主动脉连续。结果 1例术后40d由于误吸死亡,其余痊愈出院,存活病例随访3～3 6个月,无吻合口狭窄,恢复良好。结论 同期手术治疗先天性心脏病主动脉缩窄合并心内畸形有良好疗效。彻底切除缩窄段纤维组织有利于防止再缩窄。

Objective To explore the efficacy of one-stage correction of coarctation of aorta (CoA) with intracardiac anomalies. Methods Among 12 cases (male 7, female 5), there were 7 cases diagnosed as CoA with patent ductus arteriosus (PDA) and ventricular septal defect (VSD), 4 with PDA and atrial septal defect (ASD), and 1 with PDA and partial atrioventricular septal defect (P-AVSD). The mean age was (5.2±4.1) years (1-9 years). All patients revealed severe pulmonary hypertension. In 10 cases, which had been diagnosed as CoA with intracardiac anomalies preoperatively, the PDA were cut and sutured, and then separated carefully around the CoA and resection port of aortic coarctation with end-to-end anastomosis through left posterior thoracotomy. Immediately after this, the intracardiac anomalies were corrected via median sternotomy on-pump. Another two patients, who were diagnosed with CoA during or postoperative intracardiac operation, accepted reoperation to treat CoA through the left posterior thoracotomy. Results One case died from choke by food 40 days later. Others were followed up from 3 to 36 months, and recovered well and no re-stenosis of anastomosis occurred. Conclusion It is a better way to correct the coarctation of aorta associated with intracardiac anomalies at one-stage.