32例心内膜垫缺损的外科治疗

The surgical treatment for the atrioventrcular canal defects in 32 cases

目的讨论和总结心内膜垫缺损外科治疗的方法和安全性。方法分析全组32例心内膜垫缺损病人的手术方法和诊疗过程,重点讨论了瓣叶裂和房室间隔缺损的修补,房室瓣返流的纠正和防止传导束的损伤。结果25病人心功能恢复到I级,6例II级。12例病人术后二尖瓣轻度返流,4例三尖瓣轻度返流,1例二尖瓣中重度返流。早期1例III度房室传导阻滞,术后心率维持在50次/分左右(未用起搏器时),出院后2年随访心率没有明显改善,病人心功能II级。全组死亡1例,原因为术后持续的低心排,于术后第三天救治无效死亡。结论心内膜垫缺损外科治疗效果满意,手术关键是防止传导束的损伤和术后补片残余漏,以及二尖瓣返流的纠正效果。术者的细心和经验是手术成功的关键。

Objective To evaluate the ways of surgical treatment for the artrioventricuiar canal defects. Methods To analyze the operation ways of atrioventricular canal defects, fousing on the repair of ostium prium, atrial and ventricular septal defect, the correction of reflux in artio- ventricular valve and the protection for the injury of conducting bundle. Results Cardiac functions recover to grade Ⅰ in 25 cases,grade Ⅱ in 6 cases,postop- erative low-grade reflux of mitral valve in 12 cases,low-grade reflux of tricuspid valve in 4 cases, moderate-serve reflux of mitral valve in 1 case. In early stage, Ⅲ degree atrioventricular block happened in 1 case, whose heart rate maintained around 50 ppm and didn＇ t improve during thd 2 years follow up. One case died of low cardiac output syndrome in 3 days postoperatively. Conclusions The surgical treatment for atriorentricular canal defects is satisfactory, The key procedures is to protect the damage o! conducting bundle and postopertive remnant shunt of patch, the correction of reflux of mitral valve. Experience and attention of the operator are the key factors to success.