肺动脉右心室直接吻合纠治复杂先天性心脏病

Direct anastomosis between main pulmonary artery and right ventricle in the repair of complex congenital heart disease

目的 探讨肺动脉右心室直接吻合纠治复杂先天性心脏病的效果。方法 2 0 0 1年3月至2 0 0 4年6月,对17例复杂先天性心脏病病儿采用肺动脉右心室直接吻合方法予以纠治,其中3周岁以下者11例。肺动脉闭锁合并室间隔缺损6例,完全性大动脉错位合并室间隔缺损和肺动脉狭窄4例,永存动脉干4例,法洛四联症合并冠状动脉横跨右心室流出道3例。12例一期根治,5例分期纠治。结果 手术死亡1例。5例分期手术中的3例已成功二期根治。随访1～4 0个月,所有病儿生长发育良好,心功能0～I级。结论 肺动脉右心室直接吻合应用于纠治某些复杂先天性心脏病可取得满意效果。对无同种带瓣管道可选用的婴幼儿病例,此术式尤为适用。

Objective To evaluate the results of direct anastomosis between the main pulmonary artery and right ventricle in the repair of complex congenital heart disease. Methods Between March 2001 and June 2004, seventeen patients with complex congenital heart disease underwent direct anastomosis between the main pulmonary artery and fight ventricle. Among them, eleven patients were under 3 years old. Six patients had pulmonary atresia and ventficular septal defect （VSD）, 4 had transposition of the great arteries and VSD, 4 persistent truncus arteriesus and 3 TOF with coronary artery straddling RVOT. Twelve patients underwent one stage complete corrective repair and 5 patients received staged procedures. Results There was 1 operative death with hospital mortality of 5.9%. Three out of 5 staged patients succeeded in the second corrective repair. At follow-up ranging from 1 to 40 months, all patients were growing well and their heart function were in NYHA class 0 or Ⅰ. Conclusion Direct anastomosis between the main pulmonary artery and right ventricle can provide good results in the repair of certain complex congenital, heart disease, especially in infant patients without suitable homograft.