先天性心脏病并重度肺动脉高压的外科治疗

SURGICAL TREATMENT OF CONGENITAL HEART DISEASE AND PULMONARY HYPERTENTION

目的 探讨先天性心脏病合并重度肺动脉高压的外科治疗方法。方法 19例均在体外循环下手术治疗。 6例采用右胸切口 ,13例采用正中切口。房间隔缺损用自体心包片修补 ;室间隔缺损 (直径 1.2～ 3.0cm )均采用涤纶片修补 ;动脉导管未闭在并行循环下切开肺动脉 ,于导管置入Foley氏尿管注水暂时堵住血流 ,采用涤纶片修补或双头针褥式缝合。手术前、后应用前列腺素E1降低肺动脉压。结果 18例手术顺利 ,术后肺动脉压下降 3.5～ 6 .0kPa。 1例术后早期死于不可复性右心功能衰竭。死亡率 5 .3%。结论 准确掌握手术适应证 ,术中减少心肌及肺血管损伤 ,充分的围术期处理是手术成功的关键。

Objective To explore the surgical treatment of congenital heart disease and severe pulmonary hypertension.Methods 19 patients received surgical repairs under cardiopulmonary bypass(CPB).Right thoractomy was performed in 6 cases and sternotomy in other 13 cases.Atrial septal defect(ASD) was repaired with pericardial autograft and ventricular septal defect(VSD,with a diameter of 1.2～3.0cm) was repaired with dacron patch.With the arterial duct being patent and through the pulmonrary incision under parallel CBP,the blood flow was temporarily blocked by a Foley's urinary catheter with water-infused balloon and the dacron patch repair or mattress suture with double ended needle was made in operation.Results 18 cases underwent the surgical treatment successfully with their postoperative pulmonary artery pressure decreased by 3.5～6.0kPa and only 1 case died of refractory right heart failure postoperatively with the mortality being 5.3%.Conclusion The key to this kind of surgical treatment is to define the surgical indications precisely,to reduce the intraoperative myocardial and pulmonary vascular injuries and to take good measures in perioperative treatment.