婴幼儿完全性房室隔缺损的外科治疗

Surgical correction of complete atrioventricular septal defect in infants

目的 总结婴幼儿完全性房室隔缺损外科治疗的临床经验.方法 本院2004年6月至2013年12月共手术治疗婴幼儿完全性房室间隔缺损56例,年龄53 d至12个月.全部患者术前经心脏超声检查确诊,其中18例患儿同时行心脏血管CTA检查.Rastelli A型44例,B型3例,C型9例.手术采用单片法修补37例,双片法修补3例,改良单片法修补16例.术后机械通气时间26 ～ 172 h,住ICU时间3～19d.结果 术后早期院内死亡5例,死亡原因分别为严重低心排2例,肾功能衰竭2例,严重肺部感染1例;晚期死亡1例,术后2个月因二尖瓣中、重度返流,死于心肺功能衰竭.手术死亡率10.7％ （6/56）.47例患儿术后随访3个月至5年,心功能恢复良好.结论 完全性房室间隔缺损一旦诊断明确应在生后6个月至1周岁及时手术,早期手术临床效果满意.手术效果关键取决于对心内结构的仔细探查以及彻底纠正心内畸形.

Objective To summarize the clinical experience of surgical treatment for complete atrioventricular septal defect in infants.Methods From December 2013 to June 2004,56 patients aged from 53 days to 12 months with complete atrioventricular septal defect were undergone operations.All patients were diagnosed by 2D-echocardiography,and 18 patients underwent cardiovascular computed angiography （CTA）.Rastelli type A had 44 cases,type B 3 cases,and type C 9 cases.The single pericardium patch repair was used for 37 cases,the two-patch repair for 3 cases,and the modified single-patch repair for 16 cases.The time of mechanical ventilation was 26 to 172 hours,and the time of staying at Intensive Care Unit （ICU） was 3 to 19 days.Results There were 5 early deaths caused by severe low cardiac output in 2 cases,renal failure in 2 cases,and severe pulmonary inflammation in 1 case.One late death was due to severe mitral regurgitation with pneumonia and heart failure.The operative mortality was 10.7％.A total of 47 patients was followed-up for 3 months to 5 years after surgery and their heart function was satisfactory.Conclusions The operation should be done between 6 months and 1 year when the diagnosis of complete atrioventricular septal defect （CAVSD） is clear.Its early surgical intervention is satisfactory.The result of surgical treatment for CAVSD depends on both probing intracardiac anatomy carefully and complete correction of associated cardiac abnormalities.