左室心尖部限制性小切口治疗肌部多发性室间隔缺损

Surgical Closure of Multiple Muscular Ventricular Septal Defects Through a Limited Apical Left Ventriculotomy

目的:探讨经左室心尖部限制性小切口治疗小儿肌部多发性室间隔缺损的效果。方法:13例肌部多发性室间隔缺损,于左心室心尖部少血管区距左前降支1cm处做一短的"鱼嘴状"限制性小切口,长约1.5-2.0cm。应用拉钩牵开室壁切口,显露室间隔缺损。所有缺损采用Dacron补片、4-0prolene连续缝合修补。心尖切口用毛毡片"夹心法",采用2-0prolene穿过室壁全层,连续缝合。观察术后左心室射血分数,残余分流、心律失常、心尖运动不良、室壁瘤等发生情况。结果:本组患儿无手术死亡及残余分流。术后早期频发室性早搏1例,Ⅲ度房室传导阻滞1例,术后2周均恢复自主心律。经随访,所有患儿左心室射血分数正常(平均55%),无心律失常、心尖运动不良、室壁瘤等情况发生。结论:经左室心尖部限制性小切口治疗肌部多发性室间隔缺损,心肌损伤小、缺损暴露最佳,使修补直观、简单,术后并发症少,是合适、有效的手术路径。

Objective：To discuss the curative effect of apical ventricular septal defect（VSD） in children through limited apical left ventriculotomy.Methods：A limited ＂fish-mouthed＂ incision（1.5-2.0 cm） was made in bloodless region of the apex of left ventricle about 1 cm away from anterior descending coronary artery.VSDs were exposed by pulling left ventricular wall with two hooks.All VSDs were closed by using a Dacron patch and continuous sutures with 4-0 prolene.The limited apical left ventriculotomy was then closed with doublelayer felts and 2-0 prolene suture.The rates of residual shunts,arrhythmia,apical dyskinesia and ventricular aneurysm were investigated postoperatively.Results：There were no surgical deaths and residual shunts occurred.Only one complete atrioventricular block and one ventricular premature beat were found early after operation.Both cases returned to normal rhythm before discharge from hospital.All children＇s left ventricular ejection fractions were normal.No other arrhythmia,apical dyskinesia and ventricular aneurysm happened.Conclusion：The limited apical left ventriculotomy could provide better exposure for apical VSDs,and the rates of residual shunts,arrhythmia,apical dyskinesia and ventricular aneurysm are very low.It is a suitable and effective surgical approach for apical ventricular septal defects.