婴幼儿主动脉缩窄合并心脏畸形的外科治疗

Surgical Management for Coarctation of Aorta Associated with Heart Anomalies in Infants

目的分析婴幼儿主动脉缩窄合并心脏畸形外科治疗的近远期疗效,探讨此类患者适宜的外科处理方法。方法回顾分析1998年5月至2006年11月期间在我院治疗的29例婴幼儿主动脉缩窄合并心脏畸形的临床资料,其中3例应用锁骨下动脉片翻转法,6例应用狭窄段切除和端侧吻合法,20例应用狭窄段切除和端端吻合法进行主动脉缩窄的矫治;并通过电话或书信对患者远期效果进行随访。结果手术死亡3例,其中1例死于低心排血量综合征,1例死于败血症,1例死于多器官功能衰竭。随访2个月～8年,无晚期死亡,无严重的神经系统并发症。术后发生再狭窄2例,患者均无自觉症状,继续随诊观察。全组未发现体循环高血压、动脉瘤形成和主动脉瓣反流等并发症。结论婴幼儿主动脉缩窄矫治术手术死亡率较低,术前心功能差和术后长时间机械呼吸是手术死亡的高危因素。术后再狭窄是婴幼儿主动脉缩窄患者主要的晚期并发症。

Objective To investigate the optimal surgical approaches for coarctation of aorta（CoA） associated with heart anomalies（CoA-HA） in infants through analyzing the immediate and long-term outcome post-operation. Methods From May 1998 to November 2006, 29 patients with CoA-HA were admitted to this institute. Subclavian flap angioplasty was performed in three patients, excision of coarctation and end-to-side anastomoses in six patients, and end-to-end anastomoses in the remaining 20 patients. Their clinical data were retrospectively reviewed and the long-term follow-up results obtained through telephone or letters. Results Three patients died of operations, of whom one died of low cardiac output syndrome, one died of sepsis and one died of multiple organs failure. In two months＇ to eight years＇ follow-up, no later death and severe neurological complications were found. Two patients suffered from recurrent coarctation, but had no sense of symptoms and free from re-operation. In all patients neither systemic hypertension, nor arterial aneurysm and aortic valve regurgitation were found. Conclusions Mortality of surgical corrections is accepted for CoA-HA in infants. Preoperative heart dysfunction and prolonged mechanical ventilation are the high risks of operative death. Recurrent coarctation is the major later complication.