部分型房室管畸形的外科治疗

Surgical treatment of partial atrioventricular septal defect

目的探讨部分型房室管畸形的外科治疗方法。方法在52例部分型房室管畸形中,以自体心包修补、缝合瓣裂、乳头肌劈开及延长等方法矫正房室瓣关闭不全,分别采用Kirklin法和McGoon法修复原发房间隔缺损(PASD)42例、10例。结果手术死亡率3.8%,McGoon方法修补组发生Ⅲ度房室传导阻滞30%(3/10),而Kirklin法则无一例发生。47例术后随访2个月～22年,远期死亡率2.2%,5例心脏听诊心尖区可闻SMⅡ/6级,2例Ⅱ～Ⅲ/6级。结论根据二尖瓣畸形的病变解剖差异,选择个体化处理方法;用Kirklin法修复PASD比较安全。

Objective To evaluate the surgical methods of partial atrioventricular septal defect （PAVSD）. Methods Fifty-two patients with PAVSD were treated from Jan. 1981 to Dec. 2006. The atrioventricular valve regurgitation was repaired with different methods. The ostium primum a-trial septal defects were closed with Kirklin＇s method in 42 cases and McGoon＇s in 10 cases respectively. Results There were two early deaths （3.8 % ） and one late death （2.2 % ）. Three patients developed complete atrioventricular block in McGoon＇s method repair group,but no in Kirklin＇s. Seven patients had mild or moderate left atrioventricular valve insufficiency after repair. Conclusion The methods of atri-oventriculal valve repair should be individualized according to the morphology of PAVSD. Kirklin＇ s method can be safely accomplished in the majority of PAVSD repairs.