右腋下小切口心脏不停搏修补房室间隔缺损24例临床分析

Repair of atrioventricular dissociation defects through right subaxillay incision with non-stop cardiac impulse:report of 24 cases

目的:总结右腋下小切口心脏不停搏房室间隔缺损修补术的临床经验。方法:对24例房室间隔缺损等先天性心脏病均采用右腋下小切口体外循环下心脏不停搏手术进行矫治,其中2例合并部分型肺静脉异位引流(partial anomalous pulmonaryvenous connection,PAPVC)者扩大房缺,并用补片将引流到右房的右肺静脉隔到左心房,2例合并肺动脉瓣狭窄者行瓣叶交界处切开,3例合并三尖瓣关闭不全者行三尖瓣成形术。结果:全组无手术死亡,无残余分流、气栓、低心排血综合征等并发症。2例手术中分别损伤右房后壁及右下肺静脉,1例出现一过性血红蛋白尿,1例出现心律紊乱。结论:右腋下小切口体外循环下心脏不停搏手术方法具有微创意义,但使用有一定局限性,应建立在安全、精确的心脏畸形纠治基础上。

Objective：To summarize the experience in repairing the atrioventricular dissociation defects by microtraumatic surgery with non-stop cardiac impulse. Methods ： Twenty-four cases of congenital atrioventrieular dissociation defects were repaired through the right subaxillay incision with extracorporeal circulation and the heart beating. The atria defects in 2 cases complicated with partial anomalous pulmonary venous connection （PAPVC） were enlarged and the right pulmonary vein which had been drained to the right atrium was isolated to the left atrium with a displaced septum;the valve junction incision was performed in 2 cases complicated with pulmonary valve stenosis,3 cases complicated with tricuspid valve incompetence received tricuspid valve plastic operation. Results： No deaths or complications such as residual shunt, gaseous emboli or low cardiac output were observed. The right atrium posterior wall and the right lower pulmonary veins in 2 of the cases were damaged separately; 1 had transient hemoglobinuria and 1 arrhythmia. Conclusions： The procedure of right suhaxillay incision with extraeorporeal circulation and non-stop cardiac impulse causes little trauma, but it must be operated safely and accurately.