259例室间隔缺损合并动脉导管未闭的外科治疗

Surgery of ventricular septal defects associated with patent ductus arteriosus

目的：回顾性分析259例室间隔缺损（VSD）合并动脉导管未闭（PDA）外科治疗的临床资料，探讨其外科治疗经验和浅低温心脏不停跳技术的应用。方法：采用浅低温体外循环心脏不停跳技术行动脉导管结扎或缝合术以及VSD修补术，其中男性121例，女性138例，年龄2个月～38岁；合并畸形有房间隔缺损或卵圆孔未闭；主动脉缩窄；主动脉瓣下狭窄；瓦氏窦破裂；二尖瓣重度关闭不全等；直接分离结扎导管89例；其余病例经肺动脉切口缝合；其中利用补片修补动脉导管3例；合并畸形均同期手术矫治。结果：全组早期5例死亡，病死率1．9％，1例死于顽固心律失常，2例死于低心排出量综合征，2例死于手术后肺动脉高压危象合并肺部感染，随访3个月～7年，复查心脏超声均未发现VSD残余分流，无远期死亡病例。结论：VSD合并动脉导管未闭一旦明确诊断，应该早期手术治疗，以避免肺动脉高压的发生。手术中探查和进行肺动脉压力，主动脉压力比值测定有助于手术方式的选择和制定围手术期处理方案，心脏不停跳技术可作为安全有效的方法应用于VSD合并PDA的外科治疗。

Objective： To discuss treatment of 259 patients, who suffered from ventricular septal defects （VSD） associated with patent ductus arteriosus （PDA）. Method： Among 259 cases, there were 121 males 138 females,aged from 2 months to 38 years, concomitant deformities include atrial septal defects, coarctation of the aorta, subvalvar aortic stenosis, severe incompetence of mitral valve directly ligation of the PAD with 89 eases, suture close of the PDA via the pulmonary artery incision with the rest of patients, From patches repires were used in 3 patients. Result：5 deathes occurred（2.2 % ）, 1 dead from obstinate arrhythymia, 2 from low cardiac output syndrome, other 2 patients dead from pulmonary hypertesion crisis and infections. Follow-up started from 3 months to 7 years after operation. There was no late death, no residual shunt demonstrated on echocardiograph. Conclusion： Operation should be performed on patients with VSD and PDA, when the indications are confirmative. The earlier the operation is performed, the less the complications occurred. Exploration and the ratio of the pressure of pulmonary artery /aortic artery would be helpful to access the prognosis surgical repair of VSD and PDA on a beating heart could be safe and reliable.