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先天性心脏病术后继发主动脉瓣下隧道样狭窄的外科治疗分析 被引量:5

Surgical treatment results of secondary tunnel-like subaortic stenosis after congenital heart disease operations
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摘要 目的总结并分析先天性心脏病(CHD)术后出现主动脉瓣下隧道样狭窄的形成原因,评价手术疗效,以期改善预后。方法回顾性分析2009年1月至2015年12月CHD术后出现主动脉瓣下隧道样狭窄并需手术治疗的25例患者临床资料,男17例,女8例。矫治CHD时的年龄1个月~42岁,中位年龄1岁;矫治左心室流出道狭窄时年龄2岁10个月~48岁,中位年龄5岁8个月。疾病病种包括右心室双出口、室间隔缺损、部分性房室间隔缺损等。矫治手术类型有:改良Konno手术,经典Konno手术,纤维肌性隆起的切除手术,圆锥间隔的切除以及心室内板障的拆除和心室内隧道的重建。结果矫治术前中位主动脉跨瓣压差81mmHg(43-159mmHg)(1mmHg=0.133kPa),矫治术后中位主动脉跨瓣压差8.2mmHg(4.0-46.2mmHg),无住院死亡患者,术前有症状患者,术后症状均消失。2例患者术后出现Ⅲ度房室传导阻滞,于住院期间行永久起搏器置入术。随访4个月~6年,中位随访时间2年,无主动脉瓣下再狭窄,无死亡。结论继发于CHD术后的主动脉瓣下狭窄,是左心室流出道血流动力学紊乱,形成湍流,血流冲击流出道,形成剪切力,从而引起左心室流出道纤维肌肉增生导致的。改良Kon—no手术或圆锥间隔切除术,手术安全且效果满意。 Objective To summarize surgical results of secondary tunnel-like subaortic stenosis (STSS) after congenital heart disease(CHD) operations, analyze the pathogenesis of STSS, evaluate the operative effect and prognosis. Methods We analyzed clinical data of 25 patients who underwent surgical repair for STSS in Fuwai Hospital from January 2009 to December 2015. There were 17 males and 8 females. CHD types included double outlet right ventricle, ventrieular septal defect and par- tial atrioventricular septal defect, et al. The median age of the patients when they received their first CHD operations was 1 year ( 1 month to 42 years). The median age of the patients when they received TSS repair was 5 years and 8 months(2 years and 10 months to 48 years). The surgical types contained modified Konno procedure, Konno procedure, resection of the conal sep- rum, resection of fibromuscular ridge and myectomy, removal and reconstruction of the intraventricular baffle. Results All the patients successfully received their TSS repair. There was no surgical death in this study. The preoperative gradient of aortic valve pressure was 81 (43 to 159 )mmHg( 1 mmHg = 0. 133 kPa), and the postoperative gradient was 8.2 (4.0 to 46.2 ) ram- Hg. m degree atrioventricular block was occurred in 2 patients after operation and both 2 patients needed to set permanent pacemaker. All the patients were followed up after discharge for a median duration of 2 years( 4 months to 6 years) . During follow-up, none of the patients had any clinical symptom or subaortic restenosis, and there was no late death. Conclusion The pathogenesis of STSS is perhaps related to turbulent flow and shear stress to the left ventricular outflow tract, resulting in the proliferation of fibromuscular marterials and stenosis in the left ventricular outflow tract. The modified Konno procedure and resection of the conal septum are safe and effective.
出处 《中华胸心血管外科杂志》 CSCD 2017年第1期16-20,共5页 Chinese Journal of Thoracic and Cardiovascular Surgery
基金 公益性行业科研专项项目(201402009)
关键词 主动脉瓣下隧道样狭窄 改良Konno手术 湍流 剪切力 Tunnel-like subaortic stenosis Modified Konno procedure Turbulent flow Shear stress
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