动脉导管未闭合并心脏畸形和/或瓣膜病变的外科处理

Surgical management of patent ductus arteriosus accompanied by other anomalies and valvular diseases of heart

为探讨34例动脉导管未闭合并心室间隔缺损16例，心房间隔缺损4例，肺动脉瓣和／或流出道狭窄3例，主动脉瓣下狭窄3例，法乐四联症，三联症，室间隔缺损合并二尖瓣上狭窄和主动脉缩窄各1例，瓣膜病变7例治疗经验。采用超声心动图和多普勒诊断，必要时施行左右心导管，甚至左心室造影确诊，再施行手术治疗。结果：体外循环前或体外循环后先行动脉导管缝扎或补片缝补，然后再纠治心内畸形。死亡6例，病死率17．6％。本文结果提示：动脉导管合并心脏和／或瓣膜病变宜早期诊断及早手术，可取得良好效果，病变延至晚期动脉导管未闭合并左-右分流心脏畸形，可并发肺动脉高压，降低疗效，增加病死率。

34 cases PDA are complicated with VSD(16 cases), ASD (4 cases), PS(3 cases), subaortic stenosis (3cases), F4, F3, VSD with sapra-mitral stenosis and coarctation were one case of each. Another 7 patients were complicated with valvular diseases. diagnosis was established by echocardiography Doppler. If necessary, left and right catheterangiocardiography were performed. PDA was ligated before cardio-pulmonary bypass and closed by sutures with pledgetor patCh repair through the pulmonary artery incision after bypass was established. Six(17. 6 % ) patients died in the hospital. Early diagnosis and sugical intervention are the key to the effective treatment of PDA associated with congenitalcardiac anomalies and/or valvular diseases. If treatment is late, it will complicate pulmonary hypertension. In left toright shunt cases operative results is bad and mortality is increased.