室间隔缺损合并中重度肺动脉高压108例外科治疗

Surgical Treatment of Ventricular Septal Defects with Moderate or Severe Pulmonary Hypertension:A Report of 108 Cases

目的:探讨先天性心脏病室间隔缺损(VSD)合并中重度肺动脉高压的外科治疗及围术期处理。方法:全组108例,年龄4～96(24.5±16.8)个月,体重4.7～20(11.4±6.8)kg。均有明显临床症状。其中32例为双动脉干下型 VSD,其中4例伴有主动脉瓣脱垂和中度以上主动脉瓣返流。32例双动脉瓣下型 VSD 经肺动脉横切口,其他经右心房切口54例,右心室切口18例,另4例经右房右室双切口完成修补。结果:全组无死亡,2例发生右侧气胸,5例有左侧肺不张,无其他严重并发症。均顺利撤离呼吸机,拔除气管插管。结论:室间隔缺损合并中重度肺动脉高压的外科治疗,其成功的关键在于手术适应证掌握正确,术前准备充分,手术技术进步以及术后处理适当。

Objective:To explore the surgical treatment of ventricular septal defects(VSD) with moderate or severe pulmonary hypertension.Methods:The open heart operation for closure of VSD was performed on 108 infants.Their ages were 24.5+16.8 months and weight was 11.4 ±6.8 kg.The types of VSD were subarterial in 32 infants and perimembranous in 76.According to informations from echocardiography,47 cases were associated with moderate pulmonary hyper- tension and the other 61 with severe pulmonary hypertension,Incisions were made on pulmonary artery(32),right atrium(54),right ventricle(18)and on both right atrium and right ventricle (4).Results:No perioperative death occurred.All patients were weaned from mechanical ventila- tion in 4～36 hours.Main complications were right pneumothorax in 2 infants and left pulmonary atelectasis in 5.Conclusions:Proper perioperative management is very important to the surgical treatment for VSD with moderate or severe pulmonary hypertension in infancy.