62例室间隔缺损合并主动脉瓣脱垂的外科治疗

Surgical treatment of ventricular septal defect with aortic valve prolapse in 62 cases

目的 总结室间隔缺损（VSD）合并主动脉瓣脱垂的外科治疗经验.方法 2001年1月至2010年12月间,我院收治62例VSD合并主动脉瓣脱垂患者,行单纯VSD心内修复术31例、主动脉瓣置换术（AVR）29例、主动脉瓣成形术（AVP）11例.结果 术后早期死亡2例,1例VSD修补和AVR患者术后3 d因室性心律失常死亡;1例15岁患者,7年前在外院行VSD修复和AVP,复查超声心动图示主动脉瓣重度关闭不全、巨大左心室,再次行AVR,术后1周因心衰死亡.余60例均存活.术后门诊随访,随访时间6个月至10年,共55例,随访率91.7 %.心功能Ⅰ级50例、Ⅱ级5例,均能从事正常生活及学习.1例单纯VSD修复患者出现VSD残余漏,术后1年复查超声心动图示主动脉瓣中度关闭不全,行AVR,目前已治愈.11例AVP患者中,轻度关闭不全8例（2例为肺动脉瓣下VSD,6例为围膜部VSD）;轻-中度关闭不全2例（均为围膜部VSD）;中度关闭不全1例（围膜部VSD）,于术后5年行AVR后治愈.行全迷宫双极射频消融术治疗心房颤动1例,患者心律转为窦性心律.结论 根据主动脉瓣脱垂的程度,合理处理VSD及主动脉瓣病变,可取得满意的疗效.

Objective To summarize the surgical treatment experience of ventricular septal defect （VSD） with aortic valve prolapse. Methods Cardiopulmonary bypass surgery operation were performed in 62 patients with VSD and aortic valve prolapse from January, 2001 to December, 2010 in our hospital,including simple VSD repair in 31 cases, aortic valve replacement （AVR） in 29 cases, and aortic valvuloplasty （AVP） in 11 cases. Results Among 62 cases, early death occurred in 2 cases： one ease of VSD repair and AVR patients 3 days after death due to ventrieular arrhythmias, one case of 15-year-old patients outside the hospital seven years ago VSD repair and AVP, aortic review eehoeardiography valve with severe regurgitation, large left ventricle, re-line AVR, 1 week after death due to heart failure. More than 60 cases were survived. Postoperative outpatient follow-up, follow-up time： 6 months to 10 years in 55 cases, follow-up rate of 91.7%. Grade Ⅰ 50 cases of cardiac function, 11 5 cases, can engage in normal life and learning. One case of VSD repair in patients with simple VSD residual shunt, echocardiog-raphy 1 year after aortic valve with moderate regurgitation icon line AVR, has been cured. 11 cases of AVP patients, mild regurgitation in 8 eases（2 cases of subpulmonary VSD patients, 6 were around the membranous VSD patients）, light-moderate regurgitation （2 cases were around the membranous VSD patients）; moderate regurgitation in 1 case （around the membranous VSD patients）, after 5 years after AVR line cure. Total bipolar radiofrequency maze abla-tion operated for atrial fibrillation converting to sinus rhythm in 1 patient. Conclusion According to the degree of aortic valve prolapse, reasonable handling VSD and aortic valve disease, can lead to satisfactory results.