Ebstein心脏畸形手术的围术期处理

Perioperative management of corrective surgery for Ebatein's anomaly

目的:总结Ebstein心脏畸形手术围手术期的处理经验。方法:回顾性分析1983年至2003年手术治疗139例Ebstein心脏畸形患者的资料,其中行三尖瓣成形、房化右心室折叠和三尖瓣环Devaga成形111例,三尖瓣置换术27 例,右室发育不全行心外管道全腔静脉-肺动脉连接术(ETCPC)1例。结果:全组手术死亡12例(8.6%);近10 年手术死亡率降至3.3%。成形组中10例再次行瓣膜置换术,均生存。结论:(1)术前积极改善心功能,防治心律失常;(2)根据Ebstein心脏畸形病理解剖特征选择手术方案;(3)加强术后监护及综合治疗措施,及时纠正术后低心输出量综合征,积极防治术后心律失常等均为提高Ebstein心脏畸形手术成功率的诸因素。

Objective: To summarize the experiences of perioperative management of corrective surgery for Ebatein's anomaly. Methods:The data of 139 patients receiving corrective surgery for Ebatein's anomaly during 1983-2003 were analyzed. Among them, 111 cases received atrialized ventricle plication, tricuspid valve plasty and Devaga tricus-pid annuloplasty, 27 cases underwent tricuspid valve replacement. One case of right ventricular hypoplasia received extra total cavopulmonary connection. Results: There were 12 operative deaths (8. 6%) in whole group. While in the later 10 years, operative mortality rate was reduced to 3. 3%. In the group of plastive operation. 10 cases were reoper-ated with valve replacement and all were survived. Conclusion: The factor affecting surgical survival rate incluede:enhancement of patients cardiac function before operation and prevention of cardiac arrhythmias; Operative method of Ebstein's anomaly should be decided according to the pathologic-anatomic feature; Strict, intensive surveillance and promptly synthesized treatment for low cardiac output syndrome, cardiac arrhythmia.