婴幼儿主动脉缩窄合并心内畸形的外科治疗

Surgical treatment of aortic coarctation with intracardiac anomaly in infants and toddlers

目的探讨婴幼儿主动脉缩窄合并心内畸形的外科治疗经验。方法2000年1月至2006年12月，84例主动脉缩窄合并心内畸形患儿接受了外科手术治疗，手术年龄1个月～3岁（平均13．5个月），体重3．3～15．0kg（平均7．3kg）。12例合并复杂心内畸形，72例合并室间隔缺损和其他简单心内畸形，23例伴有主动脉弓发育不良。一期手术62例，49例正中开胸同时矫治主动脉缩窄和心内畸形，13例左侧开胸矫治主动脉缩窄，正中开胸修补心内畸形；分期手术22例。主动脉缩窄的手术方式包括补片成形42例，切除端端吻合30例，锁骨下动脉翻转6例，血管旁路3例，球囊扩张1例。在49例正中切口一期手术中，43例应用选择性脑灌注加下半身停循环，4例应用全身低流量灌注，2例应用深低温停循环。结果围手术期死亡8例，死亡率9．5％，其中3例为术前漏诊主动脉缩窄。结论婴幼儿主动脉缩窄合并心内畸形的外科治疗可获得良好的近期疗效，绝大部分患儿可采取正中切口一期手术。选择性脑灌注和下半身停循环可以有效地保护脑和重要脏器。

Objective To review the experience in repair of aortic coarctation with intracardiac anomaly in infants and toddlers. Methods From January 2000 to December 2006, 84 infants and children diagnosed as aortic coarctation with intracardiac anomaly underwent surgical treatment. Mean age of the patients was 13.5 months, with a range from 1 month to 3 years. Mean body weight was 7. 3 kg, with a range from 3. 3 to 15 kg. Twelve patients complicated with complex intracardiac anomaly. Seventy-two patients complicated with ventricular septal defect and other simple anomaly. Twenty-one patients had hypoplasia of the aortic arch. Sixty-two patients had one-stage repair. Median sternotomy was used to simultaneously repair coarctation and intracardiac defect in 49 patients. Left thoracotomy and median sternotomy were applied to repair aortic coarctation and intracardiac anomaly respectively in 13 patients. Twenty-two patients had staged repair. Operational techniques for aortic coarctation include 42 patients of patch aortoplasty, 30 patients of resection and end-to-end anastomosis, 6 patients of subclavian flap aortoplasty, 3 patients of vascular bypass, and 1 patient of balloon dilation. In all 49 patients of one-stage operation through median sternotomy, selective cerebral perfusion was used in 43 patients, deep hypothermia low flow was applied in 4 patients, deep hypothermia circulatory arrest was performed in 2 patients. Results There were 8 hospital deaths. The mortality is 9. 5%. Among 8 deaths, 3 patients were misdiagnosed. Conclusions Surgeries for aortic coarctation with intracardiac anomaly have satisfactory short-term results in infants and toddlers. Onestage repair through median sternotomy can be applied to most of the patients. Selective cerebral perfusion with deep hypothermia and circulatory arrest in lower body can protect the brain and other vital organs.