双向Glenn手术治疗成人先天性心脏病

Application of bidirectional Glenn procedure in adult congenital heart disease

目的分析双向Glenn手术治疗成人先天性心脏病的可行性。方法回顾性分析2004年12月至2015年12月我院行双向Glenn手术42例成人先天性心脏病患者的临床资料,其中男23例、女19例,年龄18~49(24.6±8.5)岁。术前诊断包括功能性单心室(FSV)14例,三尖瓣下移畸形(Ebstein畸形)11例,矫正型大动脉转位(C-TGA)7例,完全型大动脉转位(TGA)5例,右心室双出口(DORV)3例,三尖瓣闭锁(TA)2例。合并中度及以上房室瓣反流(AVVR)20例。右侧双向Glenn手术34例,双侧双向Glenn手术8例。21例在体外循环下手术,21例非体外循环下手术。其他合并畸形矫治包括Ebstein畸形矫治7例,房室瓣置换7例,房间隔造口3例,动脉导管结扎3例,主-肺动脉侧枝结扎术2例,完全性肺静脉异位引流(TAPVC)矫治1例,二尖瓣成形1例。结果术后早期死亡4例,死亡率9.5%。FSV和中度及以上AVVR是死亡的高危因素。血氧饱和度(Sp O2)从术前的78.8%±11.2%提高至出院时的89.3%±6.6%,P<0.05。随访时间6~132(41.4±33.1)个月,无死亡病例,心功能较术前显著改善[(1.9±0.4)级vs.(2.7±0.5)级,P<0.05]。结论成人先天性心脏病患者行Glenn手术是可行的,虽然早期死亡率较高,但是中远期效果令人满意,可以提高患者的Sp O2,显著改善患者的心功能,进而提高患者的生存质量。FSV和中度及以上AVVR是成人先天性心脏病行Glenn手术早期死亡的高危因素。

Objective To analyze the feasibility of bidirectional Glenn procedure （BDG） in treatment of adult congenital heart disease （ACHD）. Methods From December 2004 to December 2015, 42 ACHD patients received BDG in our hospital. There were 23 males and 19 females with a mean age of 24.6＋8.5 years （range： 18 to 49 years）. There were functional single ventricle （FSV） in 14 patients, Ebstein＇s anomaly in 11, corrected transposition of great arteries in 7, transposition of great arteries in 5, double outlet of right ventricle in 3 and tricuspid atresia in 2. Twenty patients suffered moderate or severe atrioventricular valve regurgitation （AVVR）. Half of the patients were operated upon with cardiopulmonary bypass （CPB） and the others with off-pump coronary artery bypass grafting （OPCABG）. Thirty-four patients underwent unilateral BDG shunt and eight bilateral BDG shunts. Concomitant procedures included correction of Ebstein＇s anomaly （7 patients）, atrioventricular valve replacement （7）, atrial septostomy （3）, ligation of patent ductus arteriosus （3）, ligation of major aortopulmonary collateral arteries （2）, correction of total anomalous pulmonary venous connection （1） and mitral valve repair （1）. Results The early operative mortality was 9.5% （4/42）. FSV and moderate or severe AVVR were risk factors for BDG in ACHD. Early postoperative oxygen saturation increased from 78.8%±11.2% to 89.3%±6.6% （P〈0.05）. The follow-up time was 6-132 （41.4±33.1） months. There was no death. The heart function improved （2.7±0.5 vs. 1.9±0.4, P〈0.05）. Conclusion The BDG shunt can be applied to ACHD. Although the early mortality is relatively high, the middle- and long-term results are satisfactory. The oxygen saturation increases and the heart function improves. The life quality of patients will also improve. FSV and moderate or severe AVVR are risk factorsforBDGinACHD.