Ⅰ型和Ⅱ型永存动脉干的外科治疗结果及随访分析

Mid-term Outcomes after Correction of Type Ⅰ and Type Ⅱ Persistent Truncus Arteriosus

目的分析单中心过去5年内Ⅰ型和Ⅱ型永存动脉干患者外科治疗及随访结果,以提高其临床治疗效果。方法回顾性研究分析2006年5月至2010年10月阜外心血管病医院共收治17例共同动脉干患者的临床资料,其中Ⅰ型共同动脉干13例,Ⅱ型4例;平均年龄4.7(0.7～19.0)岁。合并其它心脏畸形分别为共同瓣关闭不全、肺静脉异位引流、二尖瓣关闭不全和房间隔缺损等。术前心导管检查测得肺血管阻力(4.4±2.2)Wood.U。所有患者均行一期根治术,其中右心室到肺动脉的连接材料分别为同种主动脉(3例)、同种肺动脉(2例)和牛颈静脉管道(12例)。对所有生存患者进行随访。结果术后死亡1例,早期死亡率5.8%(1/17),生存16例;体外循环时间(165±52)min,主动脉阻断时间(114±29)min,术后呼吸机使用时间(106±148)h;有2例发生胸腔积液,2例气管切开,其余患者无相关并发症。随访16例,随访0.6～5.0年,生存质量良好,无再次手术患者。结论对于年龄错过了最佳治疗期的Ⅰ型和Ⅱ型永存动脉干患者,术前应常规进行心导管检查,对肺血管阻力在可接受范围内的患者应积极治疗,可以取得较好的近期生存率,但其远期生存率还有待进一步随访。

Objective To analyze the mid-term outcomes after correction of type Ⅰ and type Ⅱ persistent truncus arteriosus in all patients operated in our institution over the past 5 years.Methods Between May 2006 and October 2010,17 patients,mean age 4.7（0.7-19.0）years,underwent repair of truncus arteriosus（type Ⅰ in 13 and type Ⅱ in 4） in Fu Wai Cardiovascular Hospital.Some other concomitant cardiovascular malformations included truncal valve regurgitation,partial anomalous pulmonary venous connection,mitral regurgitation and atrial septal defect.Their average pulmonary vascular resistance was（4.4±2.2）Wood units detected by cardiac catheterization before operation.Repair with reconstruction of the right ventricular to pulmonary artery continuity was performed using a valved conduit in all 17 patients（aortic homografts in 3,pulmonary homografts in 2,and bovine jugular vein in 12 patients）.Survivors were followed up for assessment of residual heart lesions.Results The early mortality was 5.8%（1/17）.The mean cardiopulmonary bypass time was（165±52）min,mean aortic cross-clamping time was（114±29）min,and mean postoperative ventilation time was（106±148）h.Two patients had pleural effusion after surgery,2 patients underwent tracheostomy,and other patients recovered uneventfully.The surviving 16 patients were followed up for 0.6-5.0 years.All patients were alive with their original conduit during follow-up.No patient required re-operation for conduit dysfunction after correction.Conclusion Truncus arteriosus remains a challenging congenital heart disease.For patients with type Ⅰ and type Ⅱ persistent truncus arteriosus who have missed their best age for correction,cardiac catheterization should be routinely examined,and the operation should be performed if the pulmonary vascular resistance is under 8 Wood units before operation.Although the short-and mid-term results of surgery are good,more observations are needed to assess its long-term effect.