小儿干下型室间隔缺损的外科治疗

Surgical Treatment for Supracristal Ventricular Septal Defects in Children

目的探讨小儿干下型室间隔缺损(SPVSD)的临床特点和治疗效果。方法对 194例小儿SPVSD进行了手术治疗 ,其中补片修补182例 ,直接缝合 12例。对 8例合并中至重度主动脉瓣关闭不全 (AI)采用主动脉瓣成形术和主动脉瓣折叠悬吊术。结果死亡 4例 ,病死率2 .1%。存活 190例 ,效果满意 ,14 2例随访 3个月至 16年 ,自觉症状基本消失 ,能参加正常活动 ,无残余漏和新的主动脉瓣关闭不全发生。结论对SPVSD治疗以补片修补为主 。

ObjectiveTo explore the clinical characteristics and therapeutic efficiency of supracristal ventricular septal defects(SPVSD).MethodsOne hundred ninety-four cases of SPVSD were treated by operation, including patched repair in 182 cases and direct suture in 12 cases. The 8 cases complicated with moderate to severe aortic valvular insufficiency(AVI)were treated by valvuloplasty, plication and hanging operation of aortic valves. Results Four out of 194 patients died(mortality 2.1%),the others recovered satisfactorily,142 patients among them were followed up for 3 months to 16 years, their symptoms generally disappeared and could engage in normal activity. No residual fistula and new occurrence of aortic insufficiency were found.Conclusions SPVSD should be treated mainly with patched repair, but it would be better to treat the complicated AVI with plication stitches.