20例先天性心脏病的再次外科处理

Reoperation Surgery for Congenital heart diseases

自1991年4月至1996年11月收治20例先心病再次手术。病种有一孔型房间隔缺损合并二尖瓣畸形4例,室间隔缺损3例,法乐氏四联症3例,二孔型房间隔缺损2例,三尖瓣下移畸形2例,完全性心内膜垫缺损2例,二尖瓣脱垂、完全性大血管转位、肺动脉狭窄和三房心各1例。再次手术的病因有漏诊,技术缺点,病变发展,心内膜感染并发瓣膜病变。 本组中17例为第二次手术,3例为第三次手术。本组17例长期存活,死亡3例。死亡3例中,2例为三次手术,1例为巨大心脏,心功能均为Ⅳ级。

From april 1991 to november 1996, 20 patients were reoperated surgically,additional surgery is performed include atrial and ventricular septal defects mitral value and tricuspid value incompetence,residual subaortic stenosis,infective aortic value regurgita-tion. Several problems may be related to growth. Atypical example is the use of conduit in children with transposition of the great arteries in one case. The average interval between the two operations was 5 yeras. All of the reoperation were performed under hypothermia and CPB. Mitral replacement was done in 10 cases, aortic replacement in one case, mital and tricuspid value repair 1 case respective. Residual defects VSD. ASD in 3 cases, additional defects VSD subaortic stenosis in 3 cases, conduit repair in 1 case.There were 3 early deaths. The overall operative mortality was 15 % , however 2 patients were three operative and heart function in IV class died of low cardiac output syndrome. One case have major heart and hert functional IV class died cardiac failure.Conclusions:The availability of TEE and Doppler or angiography, the detection of additional defects, residual/recurrent drfects, staged operations growth related problem, infection, preoperative evaluation of heart functional status, avoiding too much dissection of the adherent pericardium during operation. The mitral valve through right Thorax incision.