婴幼儿先天性左室流出道梗阻的手术纠治

Surgical treatment of congenital obstruction of left ventricular outflow tract in infants and children

目的 总结婴幼儿左室流出道梗阻（ＬＶＯＴＯ） 的外科治疗经验。方法 选自我院２１ 例ＬＶＯＴＯ，年龄１１ 个月～２．９ 岁，体重８ ．７～１３ ｋｇ，主动脉瓣上狭窄３ 例、瓣膜狭窄８ 例、瓣下狭窄６ 例、复合狭窄４ 例。结果 术后死亡２ 例，病死率９ ．５ ％ ，存活病例术后随访效果满意。结论 ＬＶＯＴＯ 系进展型疾病，易并发主动脉瓣返流、细菌性心内膜炎，应尽早手术治疗。手术预后与术前左心功能、二尖瓣瓣环直径、主动脉阻断时间有关。

Objective To summarize the experience of surgical treatment in 21 cases of obstruction of left ventricular outflow tract (LVOTO) in infants and children. Methods All cases aged 11 months～2.9 years and weighed 8.7～13kg including 3 cases of supravalvular aortic stenosis, 8 aortic valve stenosis, 6 subaortic stenosis and 4 complex stenosis.Results 2 died after operation and the mortality rate was 9.5%. The results in others during follow up were encouraging.Conclusion The LVOTO is known as a kind of progressive disease and easily complicated with AI or SBE and should be operated as early as possible. It is important to avoid damage to the aortic valve, mitral valve and the orifice of cornary artery. The prognosis of this disease is mainly related with preoperative left heart function、 diameter of mitral valve and the clamping time of aorta. (Shanghai Med J, 2000, 31 33)