肌部室间隔缺损类型与外科纠治方法探讨

Pathologic anatomy and surgical treatment of muscular ventricular septal defect

目的探讨肌部室间隔缺损的病理解剖类型和外科纠治方法的选择。方法对21例肌部室间隔缺损患儿的临床资料进行分析。结果流入道缺损5例,前部缺损4例,中部缺损7例,心尖部缺损5例。经右心房或右心室修补缺损。残余缺损5例,其中流入道缺损1例,中部缺损2例,心尖部缺损2例,直径均小于0.3 cm,未处理。并发室上速2例,右束支传导阻滞8例,Ⅲ度房室传导阻滞1例,右侧气胸1例,心包积液1例,低心排2例,死亡1例。结论明确肌部室间隔缺损的病理解剖,选择合适的纠治方案能明显减少残余缺损发生率。

Objective To analyze the pathologic anatomy and surgical treatment of muscular ventricular septal defect （mVSD）. Methods The files of twenty-one patients with muscular ventricular septal defect were reviewed （January,2002 to June, 2005）. Results Among them,5 patients were inlet defect,4 were anterior defect, 7 were midmuscular defects,and 5 were apical defects. Closure of the VSDs was through a right atriotomy or right ventriotomy. The complications of the operation were residual shunt（5 cases）, supraventricular tachycardia（2 cases）, right bundle conduction block（8 cases）, Ⅲ° atrial ventricular conduction block（1 case）, right pleura（1 case）, pericardial effusion （1 case）, and low cardiac output（1 case） . One patients died after the operation. Conclusions Knowing pathologic anatomy of mVSD definitely well and choosing appropriate treatment of mVSD can decrease the rate of residual shunt significantly.