摘要
目的总结完全性大动脉转位合并室间隔缺损(VSD)及左心室流出道梗阻(TGA-VSD-LVOTO)的外科治疗效果。方法自2012年10月至2015年3月连续收治9例TGA-VSD-LVOTO患者,男5例,女4例,年龄7个月至5岁,多普勒测左心室流出道或肺动脉瓣流速(4.38±0.19)m/s,肺动脉Nakata指数(209±27)cm^2/m^2,9例患者中VSD距离主动脉瓣约5-10 cm 5例,在主动脉瓣下合并主动脉骑跨4例。其中VSD远离主动脉瓣的5例患者和VSD在主动脉瓣下的1例患者采用双根部调转(DRT)治疗;其中3例VSD在主动脉瓣下合并主动脉骑跨患者采用改良REV手术治疗。结果 1例患者术后4 h出现低心排出量综合征,应用体外膜肺氧合(ECMO)失败,多器官衰竭死亡,其余患者均痊愈出院,术后随访3-32个月,8例患者均心功能1-2级(NYHA),左心室射血分数(LVEF)(64±2.4)%,肺动脉瓣少量反流6例,中量反流2例,主动脉瓣未见反流5例,微量反流3例,血氧饱和度(Sa O2)(99±0.5)%。结论根据VSD位置选用DRT术和改良REV手术是治疗TGA-VSD-LVOTO的有效方法。
Objective To summarize the operative therapeutic effects of complete transposition of great arteries with ventricular septal defects( VSD) and left ventricular outflow tract obstruction( TGA-VSD-LVO-TO).Methods From October 2012 to March 2015,we treated 9 patients with TGA-VSD-LVO-TO,5 male and 4 female,age ranged from 7 months to 5 years old,the velocity of left ventricular outflow or pulmonary valve showed by Doppler was( 4. 38 ± 0. 19) m / s,Nakata index was( 209 ± 27) cm^2/ m^2. 5 of these 9 patients were 5-10 cm form VSD to aortic valve and other 4 patients' VSD located below the aortic valve. 6 patients were carried out double root translocation( DRT) operation,including 1 with VSD below aortic valve and 5 with VSD far away from aortic valve.The other 3 patients with VSD below aortic valve were treated by modified REV procedure. Results One patient developed low cardiac output syndrome 4 hours after the operation and was applied extracorporeal membrane oxygenation( ECMO),but died of multiple organ failure. Other 8 patients all recovered and discharged from hospital. During the 3-32 months' follow-up,8 patients all showed NYHA Class Ⅰ or Ⅱ,left ventricular ejection fractions( LVEF) was( 64 ± 2. 4) %; 6 of them had mild pulmonary regurgitation,2 were moderate pulmonary regurgitation; 5 of them had no aortic regurgitation,3 were micro aortic regurgitation,Sa O2was( 99 ± 0. 5) %.Conclusion DRT and REV are effective treatments in management of complete transposition of great arteries with left ventricular outflow tract obstruction according to location of VSD.
出处
《心血管外科杂志(电子版)》
2015年第4期16-19,共4页
Journal of Cardiovascular Surgery(Electronic Edition)
关键词
心脏缺损
先天性
室间隔缺损
室性流出道阻塞
完全性大动脉转位
双根部调转
改良REV
Heart defects
congenital
Heart septal defects
ventricular
Complete transposition of great artery
Ventricular outflow obstruction
Double root translocation
Modified REV procedure