新型左心室扩大技术在左心室较小型婴儿法洛四联症根治术中的应用

A new technology to enlarge left ventricular in radical operation of infant tetralogy of Fallot with small left ventricular

目的 探讨新型左心室扩大技术在左心室较小型婴儿法洛四联症（TOF）根治术中的应用.方法 2008年8月至2013年2月,一期根治左心室较小型婴儿TOF 41例.其中男23例,女18例;年龄2.5 ～12.0（8.71±2.52）个月;体质量5.2 ～10.8（8.73±2.06） kg;身高55.5 ～78.4（66.38±10.18）cm;左心室舒张末期容积指数（LVEDVI） 24～29 （26.51±2.92） mL/m2.所有患儿术中均采用新型左心室扩大技术增大左心室容积.结果 出院时与术前相比：左心室舒张末前后径（LVEDD）、左心室舒张末容量（LVEDV）、LVEDVI、右心室横径（RVD）、主肺动脉内径（PAD）均增加（t=-2.909,-9.786,-2.105,-2.686,-14.137,P均＜0.05）,收缩期主肺动脉血流速度（PAV）、左心室短轴缩短率（FS）减小（t=30.123,2.329,P均＜0.05）;术后6个月与术前相比：左心房前后径（LAD）、LVEDD、LVEDV、LVEDVI、RVD、PAD、左右肺动脉内径之和（LP ＋RP）均显著增加（t=-3.164,-6.441,-28.642,-5.741,-7.022,-20.174,-9.224,P均＜0.05）,PAV减小（t=41.147,P ＜0.001）;术后6个月与出院时相比：LAD、LVEDD、LVEDV、FS、RVD、LP＋RP均增加（t=-3.032,-3.083,-12.661,-2.121,-3.728,-8.229,P均＜0.05）.术后低心排出量综合征4例,急性肾功能不全2例,无严重心律失常,均治愈出院,术后随访6个月～5年,无死亡病例,恢复良好.结论 此新型左心室扩大技术可以安全有效应用于左心室较小型婴儿TOF根治术中.

Objective To investigate the clinical efficacy of the new technology to enlarge left ventricular in radical operation of infant tetralogy of Fallot （TOF） with small left ventricular.Methods Between Aug.2008 and Feb.2013,41 cases of baby TOF with small left ventricular underwent radical surgery,23 boys and 18 girls,the age ranged from 2.5 to 12.0 （8.71 ± 2.52） months,the weight ranged from 5.2 to 10.8 （8.73 ± 2.06） kg,the height ranged from 55.5 to 78.4（66.38 ± 10.18） cm,the left ventricular end-diastolic volume index（LVEDVI） ranged from 24 to 29 （26.51 ± 2.92）mL/m2.All patients were used the new technology to enlarge left ventricular volume.Results Discharge compared with the preoperative：left ventricular end-diastolic diameter（LVEDD）,left ventricular end-diastolic volume （LVEDV）,LVEDVI,right ventricular diameter（RVD）,pulmonary artery diameter（PAD） were significantly increased（t =-2.909,-9.786,-2.105,-2.686,-14.137,all P 〈 0.05）,pulmonary artery systolic blood flow velocity（PAV）,left ventricular fractional shortening （FS） significantly reduced （t =30.123,2.329,all P 〈 0.05） ; 6 months after surgery compared with preoperative：left atrial anteroposterior diameter （LAD）,LVEDD,LVEDV,LVEDVI,RVD,PAD,the sum of the left and right pulmonary artery （LP ＋ RP） were significantly increased （t =-3.164,-6.441,-28.642,-5.741,-7.022,-20.174,-9.224,all P 〈 0.05）,PAV significantly reduced （t =41.147,P 〈 0.001） ;6 months after surgery compared with discharge：LAD,LVEDD,LVEDV,FS,RVD,LP ＋ RP were significantly increased（t =-3.032,-3.083,-12.661,-2.121,-3.728,-8.229,all P 〈 0.05）.There was no severe arrhythmia in the all patients,low cardiac output syndrome was in 4 cases,2 cases had acute renal insufficiency,all patients were cured,and followed up for 6 months to 5 years,there was no death.Conclusions The new technology can be safely and effectively used to enlarge left ventricular in radical operation of infant TOF with small left ventricular.