小儿室间隔缺损术后残余漏

Postoperative Residual Shunt After Repair of Ventricular Septal Defect Among Children

８例小儿室间隔缺损修补术后残余漏再次手术病例分析：残余漏表现为５例术后残留心前区Ⅲ级以上收缩期杂音，７例血红蛋白尿，２例右心衰，８例超声心动图（ＵＣＧ）证实心室水平残余左向右分流。均于术后２～１１２天行残余漏修补。术中见残余漏原因为不同部位缝针处组织撕裂６例，修补不全２例。８例均经带垫片褥式缝合加固，７例痊愈，１例再次发生残余漏。本文对残余漏特点、诊断、手术适应证及时机进行了讨论。

Eight cases of postoperative residual shunt after repair of venticular septal defect(VSD)were analysed in this paper. Their clinical features disclosed: hemoglubinuria in 7 cases,cardiac murmur in 5 and residual shuntsigns on echocardiograph in 8.In the operation for residual shunt, it was found: the tear in septal leaflet in aneurysm-like VSD in 2 cases, the tear in septal leaflet of tricuspid in 4,infundibular muscular 2 and residual triangle defect under the patch repair in VSD 2. Residual shunt in all the 8 cases were repaired with mattress suture under cardiopulmonary bypass, seven patients recovered without hemoglobinuria or cardiac murmur, but one had residual shunt again and cerebral insufficiency, which was improved by medical therapy. The harmfulness,the diagnosis and prevention of postoperative residual shunt,the operative indication, optimal time and surgical procedures were discussed.