非体外循环经胸壁微创封堵术治疗简单先天性心脏病

Off-pump occlusion of trans-thoracic minimal invasive surgery on simple congenital heart diseases

目的总结非体外循环经胸壁微创封堵术（off-pump occlusion of trans-thoracic minimal invasive surgery，OPOTFMIS）治疗房间隔缺损（ASD）、室间隔缺损（VSD）和动脉导管未闭（PDA）的经验。方法回顾性分析2008年7月至2011年7月采用OPOTTMIS治疗92例简单先天性心脏病患者的临床资料，男38例，女54例；年龄3～56岁；体重8．0—54．5kg。其中ASD52例，VSD26例，PDA14例，术后3个月内每个月随访心电图及超声心动图检查1次，3个月后每3～6个月复查心电图及超声心动图检查1次。结果91例成功实施OPOTFMIS，1例筛孔状ASD中转开胸手术，总成功率为98．9％。1例（1．1％）成人PDA因肺动脉高压危象术后第2天死亡。4例残余少量分流（2例ASD，1例VSD，1例PDA），ASD和VSD各1例Ⅱ度房室传导阻滞，心脏穿刺点处活动出血二次开胸止血治愈ASD和VSD各1例。术后72h内总并发症发生率为6．5％（6／92例）。围术期无心脏破裂、感染性心内膜炎、溶血及血栓形成等严重并发症。术后随访3个月-4年，90例心电图检查均未见Ⅲ度房室传导阻滞。心脏超声检查均无封堵器明显移位和脱落，无明显左室流出道和降主动脉血流受限，VSD和PDA各1例存在少量残余分流，2例PDA心脏较术前扩大，均无中度以上心脏瓣膜反流。心功能NYHAⅠ～Ⅱ级。结论非体外循环经胸壁微创封堵术（OPOTTMIS）治疗简单先天性心脏病安全、可行、有效。

Objective Report an operation of off-pump occlusion of trans-thoracic minimal invasive surgery （OPOTYMIS） adopted on the therapy of 92 patients suffered with simple congenital heart diseases （CHD） of atrial septal de- feet （ ASD）, ventricular septal defect （VSD） and patent ductus arteriosus （PDA） and summarize the experiences. Methods The clinical data of 92 CHD patients administrated with OPOTTMIS in our hospital during the time of July 2008 and July 2011 were analyzed retrospectively. Moreover, the relevant literatures were reviewed and the different kinds of treatments and their outcomes of CHD were compared. These patients were 3 -56 years old and weighed 8.0 -54.5 kg, with male and female 38 and 54 cases, including ASD 52 cases, VSD 26 cases and PDA 14 cases, respectively. Within the initial 3 months of post- operation, all the patients were followed up and managed to take the re-examination with electrocardiogram and eehocardiogram one time for each month, and 3 months later, at least one time for every 3 -6 months. Results 91 cases were performed the oprI^MIS procedure successfully, 1 child with sieve-like ASD transferred to open-heart surgery and 1 adult（ 1.1% ） PDA died on the second day after operation for the pulmonary hypertension crisis. 4 cases appeared mild residual shunt including 2 of ASD, 1 of VSD and 1 of PDA. 2 cases showed 11 stage atrial ventricular block （AVB） within ASD and VSD, respectively. Al- so, post-operation hemothorax happened to 1 ease ASD and 1 case VSD for the active bleeding of cardiac puncture site and the exploration and hemostatie operation were performed. 91 （98.9%） patients were performed the OPOTTMIS operation success- fully, the total complications within 72 hours was 6.5 % （6/92） , respectively. There were no heavy complications happened during peri-operation such as cardiac rupture, infective endocarditis, stroke, hemolytic and thrombus formation. 90 patienls outcomes of 3 months to 4 year follow-up with the ECG and UCG examination showed that there were no III stage atrioventricular block, no obvious occluder shift and broken and no moderate cardiac valve regurgitation, no evident blood flow restriction of left ventricular outflow tract and des（ending aorta, only found mild residual shunt within 2 eases （ VSD and PI）A each） and heart expansion compared to pre-operation within 2 PDA patients. However, all the patients＇heart functions were in grade I to grade II according to NYHA standard. Conclusion OPOTTMIS is a safe, feasible and effective option on simple congenital heart diseases.