端端吻合术在小婴儿主动脉缩窄中的应用

Resection and end-to-end anastomosis for repair of coarctation of the aorta in small infants

目的 探讨小婴儿主动脉缩窄 (COA)端端吻合术后的近期和远期效果。方法 小婴儿COA 2 1例 ,手术经左胸后外侧切口进胸 13例 ,胸骨正中切口进胸 8例。前者体温控制在 34～ 35℃ ,而后者是在中度低温体外循环下进行 ,同时进行心内其他畸形的纠治。本组 12例行端端吻合术 ,6例行左锁骨下动脉翻转术 ,3例行Gortex补片扩大术。术毕测下肢与上肢血压差为 0～ 2 1mmHg(1mmHg =0 133kPa)。结果 12例行端端吻合术的小婴儿术后死亡 1例 ,死亡率 8 3% ;近期和远期随访 9例均无残余压差 ;6例行左锁骨下动脉翻转术死亡 1例 ,近期和远期随访分别有 1例和 2例存在残余压差 34～ 39mmHg。

Objective: To evaluate the results of resection and end to end anastomosis for repair of coarctation of the aorta in small infants. Methods: 21 patients underwent repair of coarctation of the aorta (COA). The surgical approach was through a left posterolateral thoracotomy and the temperature was controlled at 34℃～35℃ (in 13 cases, 62%). In the other 8 cases(38%), it was done through a median sternotomy and under cardiopulmonary bypass, in mean time, the other cardiac malformations were corrected. End to end anastomosis was performed in 12 cases, subclavian flap arterioplasty in 6 and patch aortoplasty in 3. The pressure difference of lower limb over upper measured after operation was 0～21?mm?Hg. Results: There was one operative death in the group of end to end anastomosis patients with a mortality rate of 8 3%. 9 patients were followed up with excellent results. In the group of subclavian flap arterioplasty patients. One patient died after surgery. Recurrence occurred in 1 patient early after operation and 2, developped later. Conclusion: The preferred surgical approach for COA in small infant is the resection and end to end anastomosis or extended end to end anastomosis.