老年房间隔缺损病人的手术治疗

Surgical treatment of isolated atrial septal defect secundum in the elderly

目的 总结老年房间隔缺损病人手术治疗经验。方法 对 12例 6 0岁以上继发孔型房间隔缺损病人进行手术治疗 ,年龄为 6 0～ 6 6岁 ,平均 (6 2 .3± 2 .4)岁 ,全部合并三尖瓣关闭不全 ,其中还合并二尖瓣关闭不全 10例 ;房颤 9例 ,房扑 1例 ;术前采用右心导管进行肺动脉测压 ,肺动脉平均压为 (5 .31± 3.12 )kPa ,最高为8.4kPa。本组房缺修补采用心包片或涤纶补片修补 ,同期行三尖瓣成形术 12例 ,其中 3例行Kay’s二叶瓣成形术 ,9例行Devage成形术 ;二尖瓣成形术 6例 ,二尖瓣置换术 2例 ,3例合并有房颤者同期行右房迷宫术。 结果 12例病人术后全部存活 ,心功能均有明显改善 ,但与其他年龄组手术病人比较 ,术后多巴胺使用时间和住院时间明显延长 ,6例发生胸腔积液 ,术后随访 3～ 6 0个月。

Objective To review the clinical experiences of surgical treatment of isolated atrial septal defect secundum in elderly patients. Methods 12 patients were over 60 years of age (range, 60～66, with a mean of 62.3 years). Coexislent disorders were moderate to severe tricuspid regurgitation in all 12 patients, mitral valve regurgitation in 10, atrial fibrillation in 9 and atrial flutter in 1. Preoperative mean pulmonary artery pressure in these 12 patients was 5.31±3.12 kPa. All patients underwent closure by Dacron and pericardial patch. 12 patients underwent either De vage or Kay tricuspid annuloplasty for TVR, and 6 mitral valve repair, 2 mitral valve replacements. Three patients with atrial fibrillation underwent right sided maze procedure.Results All patients survived the operation, heart function being improved in most patients. Conclusion Old age is not a contradiction to repair of atrial septal defect. The key element in successful operation relies on concomitent correction of the coexisted disease and postoperative cardiac support.