64例小儿室间隔缺损的外科治疗

SURGICAL TREATMENT OF VENTRICULAR SEPTAL DEFECT IN CHILDREN:ANALYSIS OF 64 CASES

浅或中度低温体外循环下手术治疗小儿室间隔缺损６４例，经右房切口５２例，经肺动脉切口１２例。３４例直径１．０ｃｍ以下的围膜部和隔瓣后空间隔缺损有完好的纤维边缘，行带垫片水平褥式缝合，直径大于１．０ｃｍ的１８例应用绦纶补片修补。１２例干下型室间隔缺损采用肺动脉切口，４例直径小于０．６ｃｍ，上缘与肺动脉瓣环之间有肌肉或纤维组织，给予直接缝合。８例直径大于０．６ｃｍ，上缘为肺动脉瓣环的作补片修补。２例合并房间隔缺损者给予同期修补，２例合并动脉导管未闭在并行循环低流量灌注下切开肺动脉直接缝闭成功。结果，全部病人康复出院，随访３个月到２年，心功能Ⅰ级者６２例，Ⅱ级者２例。提示手术适应证、手术方式的选择及围手术期的处理是成功的关键。

cases with ventricular septal defect (VSD)in children including perimembranousVSD (44), Subpulmonary VSD (R), VSD beneath tricuspid septal leaflet (8) underwentsurgical treatment,of them right atrial incision were performed in 52 cases, pulmonaryartery incision in 12 cases. 34 cases of perimembranous VSD and VSD beneath tricuspidseptal leaflet with diameter less than 1. 0 cm were sutured with pledgeted horizontalmattress sutures. 18 cases with diameter over 1. 0 cm were patched with Decron felt.Simple repair were performed in 4 cases of sunpulmonary VSD with diameter less than0. 6 cm and muscular or fibrous tissue was persent between upper margin of VSD andpulmonary annulus .patched repair in 8 cases with diameter over 0. 6cm and pulmonaryannulus formed the upper margin of the VSD. Associated lesions including 2 cases ofPDA and 2 cases of ASD were corrected simultaneously. There were no mortality andmorbidity. A follow-up of 3 months to 2 years revealed that heart function in 62 caseswas class Ⅰ (NYHA) and 2 cases class Ⅱ. The author considers that the key of succesful treatment is proper grasp of indications,selection of operative techniques and perioperative management.