右前外侧切口心脏不停跳下心内直视手术15例报告

15 cases report of open heart surgery with extracorporeal circulation and not heart arrest through an antero-lateral right thoracotomy

目的 介绍经右前外侧切口浅低温体外循环心脏不停跳下心内直视手术的经验。方法 经右前外侧第三肋间进胸,浅低温体外循环,不阻断升主动脉,不冷灌,心脏空跳慢跳下行心内直视手术15例,继发孔房间隔缺损4例,缺损直径<1.0Cm的膜周部室间隔缺损3例,左房粘液瘤1例,风湿性心脏病二尖瓣狭窄伴关闭不全6例,主动脉瓣狭窄伴半闭不全1例。结果 本组病例无手术死亡及并发症,体外循环时间与标准术式相近。结论 该切口可安全有效地替代胸骨正中切口完成一部分心脏疾病的手术,创伤的程度及术后美容效果明显优于胸骨正中切口或双乳腺下皮肤切口;浅低温体外循环心脏跳动下行心内直视手术,可明显减轻心肌缺血缺氧和心肌再灌注损伤,达到心脏微创手术的目的。

Objective The experience of open heart surgery through anterolateral right thoracotoy was introduced in beating heart with extracorporeal circulation and mild hypothermy. Methods 15 cases have been performed with such methods including 4 cases of artrial septal defect, 3 perimembranous ventricular septal defect (diameter<1.0cm), 1 left atrial myxoma. 6 mitral and 1 aortic rheumatic valve disease from Aug. Intracardiac direct-sight operation in slower beating heart undr extracorporeal circulation and mild hypothermy but no cardioplegia perfusion, no ascending aorta closure in all of patients. Results No death and complication happened in those patients. The extracorporeal circulation time was similar to standard method. Conclusion This thoracotomy is safer and more effective than median sternocotomy in treatment of some heart diseases. The degree of the operative damage was mild and this thoracotomy was better in cosmetic result postoperatively than median sternotomy or bilatral submammary incisiion. , the open heart surgery with extracorporeal circulation, mild hypothermy and not heart arrest could definitely alleviate ischemia, hypox-emia and reperfusive damage of myocardiu. Thus minor invasive oopen heart surgery was achieved.