44例完全性房室通道的外科治疗

Surgical treatment of complete atrioventricular canal defect in 44 cases

目的总结我院近年来手术治疗完全性房室通道的经验。方法我院自2003年1月至2008年12月共手术治疗完全性房室通道44例。Rastelli分型:A型43例(其中过渡型17例),B型1例。合并畸形包括:法洛氏四联症2例,动脉导管未闭6例,右室流出道狭窄2例,永存左上腔4例。手术在浅中低温体外循环下进行。采用戊二醛处理的自体心包补片连续缝合修补间隔缺损,单片法6例,双片法21例。17例过渡型采用直接下压共瓣修补室缺,间断缝合二、三尖瓣瓣裂,反复注水测试二尖瓣关闭情况直至满意。冠状静脉窦区采用浅缝合,冠状静脉窦开口留在右房。结果手术死亡1例,术后死亡2例,术后早期发生Ⅲ0AVB5例,4例经治疗在术后3周恢复窦性心律,1例安装永久起搏器。存活病例术后随访5个月～6年,症状消失,生长发育良好,心功能均低于Ⅱ级,2例失访。术后Echo检查显示二尖瓣轻度返流8例,中度返流2例,残余室间隔缺损4例,均在半年后自愈。结论完全性房室通道的患儿在诊断明确后应尽早争取在6个月内行根治性手术,同时尽量完善修复二、三尖瓣裂,会取得良好的效果。

Objective To summarize the experience of surgical treatment on patients with complete atrioventricular canal defect in our hospital in recent years. Methods From January 2003 to December 2008,44 patients with complete atrioventricular canal defect underwent the surgical treatment.Totally 43 cases in A-type （of which 17 cases of transitional type）,1 case in B-type,according to the typing of Rastelli. There were 2 patients with tetralogy of Fallot（F4）,6 with patent ductus arteriosus（PDA）,2 with right ventricular outflow tract stenosis,4 with persistent left superior vena. Surgery was operated in hypothermic cardiopulmonary bypass in a shallow manner.Dealt with using glutaraldehyde autologous pericardi-um patch for suture and repair septal defect,of which using single-patch technique in 6 cases and using two-patch technique in 21 cases.The VSD of 17 cases in transitional type were repaired under direct pressure valve,interrupted suture bicuspid and tricuspid valve split,repeating injection test until the closure of the mitral valve was satisfing. Coronary sinus was repaired by shallow suture,and coronary sinus opened in the right atrium. Results One case died during operation,2 cases died in postoperation,5 cases were occurred with atrioventricular block Ⅲ degrees in the early postoperation,4 cases restorated the sinus rhythm with treatment after three weeks,1 case installed with permanent pacemaker.Postoperative surviver were followed up 5 months to 6 years,with the symptoms disappeared,the growth and development were good and cardiac function were under II level,2 cases lost. Echo postoperative examination showed that mild degree mitral valve regurgitation was observed in 8 cases,middle degree mitral valve regurgitation was observed in 2 cases,residual ventricular septal defect was observed in 4 cases. and all were selfhealing after six months. Conclusion Children with diagnosis of complete atrioventricular canal defect should be treated with radical surgery as soon as possible,less than 6 months,with repair of the bicuspid and tricuspid valve split,which will achieve good results.