部分型房室间隔缺损的外科治疗

Surgical treatment of partial atrioventricular septal defect

目的:总结60例部分型房室间隔缺损的外科治疗经验。方法:回顾性分析经手术治疗的60例部分型房室间隔缺损患者的临床资料。二尖瓣前瓣分裂的处理,58例缝合二尖瓣裂隙,2例行机械二尖瓣置换;原发孔房间隔缺损的修补,53例采用心包片,7例采用绦纶补片;35例采用Kirklin法将冠状静脉窦口隔入左房,25例采用McGoon法将冠状静脉窦口隔入右房;同期处理合并的畸形。结果:共死亡2例,均死于低心排出量综合征,死亡率3.3%(2/60);采用Kirklin法和McGoon法手术的患者术后完全性房室传导阻滞发生率分别为8.00%(2/35),6.06%(2/25),2组比较差异无统计学意义(P>0.05);随访1月至5年,无晚期死亡,除1例3个月后复查出现二尖瓣中度返流外,余患者未出现轻度以上二尖瓣和/或三尖瓣狭窄或关闭不全,心功能均得到不同程度改善。结论:针对部分型房室间隔缺损患者,合理的手术设计、术中细致操作、避免损伤传导组织以及加强围手术期管理均可取得的良好的近、中期疗效。

Objective To summarize the experience of surgical treatments of partial atrioventricular septal defect in 60 patients. Methods From April 1999 to April 2004, 60 patients of partial atrioventricular septal defect were operated. Fifty-eight patients were performed with suture of the cleft of mitral valve and the other 2 were given mitral valve replacement; For closure of primum ASD, 53 patients with pericardial patches and 7 with Dacron patches. Coronary sinus was baffled to left atrium with kirklin procedure in 35 cases and baffled to right atrium with McGoon procedure in other 25 cases. Correct the accompanying cardiac deformity at the same time. Results The hospital mortality was 3.3%(2/60) due to low cardic output syndrome.The incidence rate of complete atrioventricular block was 8.00%(2/35) in the group with Kirklin procedure and 6.06%(2/25) in the group with McGoon procedure.There was no statistical significance between the 2 groups (P>0.05). The follow-up was from 1 month to 5 years, and there was no late death.All cardiac function were improved except middle mitral regurgitation in 1 patient. Conclusion Reasonable operative design,refined procedures,avoiding damage to conducting bundles and proper perioperative management are the key points in improving theraeutic effect.