单向活瓣补片矫治间隔缺损合并重度肺动脉高压双向分流的术后效果分析

One-way-valved Patch for Repair of Cardiac Septal Defects with Severe Pulmonary Hypertension with Bi-directional Shunt

目的评估应用单向活瓣补片治疗合并重度肺动脉高压双向分流的先天性房室间隔缺损患者的术后效果。方法对32例伴有重度肺动脉高压双向分流的房室间隔缺损患者进行回顾性分析,进行常规补片矫治术的17例,进行单向活瓣补片矫治术的15例,术后分析两组的肺动脉收缩压(SPAP)与死亡率。结果常规补片矫治组死亡3例,死亡率17.65%,2例死于肺高压危象,1例死于右心衰;活瓣补片矫治组死亡1例,死于低血容量性休克与DIC,死亡率6.67%,单向活瓣补片矫治较之常规补片矫治的围手术期死亡率明显降低;常规补片组术前SPAP平均(93.2±22.6)mmHg,术后平均(85.4±17.9)mmHg,活瓣补片组术前SPAP平均(90.4±19.5)mmHg,术后平均(57.8±12.3)mmHg,大多数患者肺动脉压逐渐下降,其中活瓣补片组肺动脉压下降比常规补片组明显。活瓣矫治组回访5例,心功能均Ⅱ级;常规补片矫治组回访6例,心功能Ⅱ～Ⅳ级。结论单向活瓣补片矫治能有效地降低间隔缺损合并重度肺高压双向分流的围手术期死亡率及术后肺动脉收缩压,同时合理的围手术期治疗及术前综合评估,手术适应症的严格掌握是降低先心间隔缺损合并重度肺动脉高压双向分流患者死亡率、提高术后近中期生活质量的关键因素。

Objective To discuss the surgical effect with one-way-valved patch to treat cardiac septal defects with severe pulmonary hypertension with bi-directional shunt. Methods The materials of 32 patients with cardiac septal defects and PH with bi-directional shunt were analyzed, 15 of whom were treated by one - way - valved patch and the rest by conventional patch. Results 4 patients died in the hospital after operation due to pulmonary hypertension crisis or the low output of left ventricle. The mortality of conventional patch surgery is 17.65% while that of one-way-valved patch surgery is 6. 67%. 11 patients returned to follow up and most felt more better than preperation and their pulmonary artery pressure decreased gradually. Conclusion One-way-valved patch is useful in decreasing the perioperative mortality and increasing short - and intermediate - term survivals. The perioperative therapy and preoperative evaluation are also essential to raise surgical operation effect.