双主动脉弓合并复杂心内畸形患者的同期矫治

Sugical repair of double aortic arch associated with complex cardiac anormalies in one stage

目的探讨双主动脉弓合并心内畸形患者的临床特点和同期矫治手术方法。方法回顾性分析4例双主动脉弓合并心内畸形患者的临床资料,着重分析手术方法和手术结果。结果4例双主动脉弓合并复杂心内畸形的患者中,2例合并法洛四联症,2例合并右心室双出口。手术经正中开胸,在锁骨下动脉远端切断一侧小弓,同时切断动脉导管或动脉韧带,松解气管食管周围组织,同期行心内畸形矫治。1例术后因呕吐误吸导致病情恶化死亡,其余3例存活,未出现与双弓矫治相关的并发症。结论双主动脉弓手术治疗可取得良好效果,对于合并心内畸形的双主动脉弓患者,可经胸骨正中切口同期矫治。

Objectives To evaluate the clinical characteristics and surgical repair methods of double aortic arch （DAA） associated with complex cardiac anomalies. Methods Retrospectively analyzed the clinical data of the 4 DAA associated with complex cardiac anomalies patients, focused on the surgical methods and the results of the operation. Results Of the 4 patients, 2 cases were with tetralogy, of Fallot （TOF） and the other 2 were with double outlet of fight ventricle. Operation was achieved via median sternotomy. The surgical technique was composed of dividing the small aortic arch, and also ligation and division of the ductus arteriosus or ligamentum arteriosus, with complete and thorough mobilization of the trachea and esophagus. The associated cardiac defects were corrected in one stage. One case worsened postoperatively by the cause of vomiting and aspiration and then died. The other three were survival, with no DAA repair relating complication. Conclusions Double aortic arch can be cured by surgical repair and DAA with cardiac defects can be operated in one stage via median sternotomy.