外科治疗先天性心脏病合并严重肺动脉高压

Surgical Multi-treatment for Congenital Heart Defects with Severe Pulmonary Hypertension

目的探讨外科治疗先天性心脏间隔缺损合并重度肺动脉高压的方法及疗效。方法选择合并重度肺动脉高压已出现双向分流的先天性心脏间隔缺损性病例29例。外科手术全部采用单向活瓣补片进行心脏间隔缺损修补,同时术中直视下留置肺动脉内置管泵入前列腺素E1（PGE1）,必要时同期行二尖瓣成形术和/或三尖瓣成形术,比较术前、术后肺动脉压及血气指标变化用,并超声心动图监测分流情况。结果肺动脉压和血气指标较术前有明显改善;随访发现2例术后持续肺动脉高压存在,单向活瓣持续右向左分流,其余27例分别于3-6个月后活瓣关闭无分流。结论单向活瓣补片修补缺损、肺动脉内置管泵入（PGE1）能明显降低肺动脉压、改善血气指标,确保合并严重肺动脉高压的患者围手术期安全;前者能在术后发生严重肺动脉高压时发挥良好的右向左分流“减压”作用,肺动脉压力下降后又能自动关闭;同期行必要的瓣膜成形术有利于降低肺动脉压、改善心功能。

Objective To evaluate effect of surgical treatments to congenital heart defects with severe pulmonary hypertention（PH）. Methods During operation,29 cases with cardiac defects were repaired with unidirectional - valve patches and intered catheters into pulmonary artery in order to inject prostaglandin E1 （ PGE1 ） directly and monitor pulmonary pressure（PP） after operation, and cases with mitral incompetence（MI） were treated with mitral valve annuloplasty（MVP）. ECG were used to monitor shunt penetrating the patch. PP and PaO2 were compared between pre - and post - operation. Results PP and PaO2 improved significantly than pre - operation. After opreration, persistent right - to left shuntings were founded penetrating unidirectional valved patch in 2 cases with consistent PH and there were no shuntings spontaneously or piecemeally in orther 27 cases. Conclusion Cardiac septal defect wihth irreversible PH is not suitable for repairment. Unidirectional - valved - patch repairing and injecting PGE1 in pulmonary artery directly can cut down PP and improve patients＇ survival.