婴儿主动脉缩窄合并室间隔缺损一期外科治疗

Surgical repair of infantile coarctation of arota with ventricular septal defect in one stage

目的总结婴儿主动脉缩窄合并室间隔缺损一期手术治疗的临床经验。方法 2008年1月-2016年12月,采用胸骨正中切口一期手术治疗婴儿主动脉缩窄合并室间隔缺损31例,手术年龄1~6月,平均4.0月,体重3.0~6.5kg,平均5.2kg。本组患儿主动脉缩窄均为导管前型,主动脉弓发育不良合并主动脉缩窄6例,本组伴有膜周型室间隔缺损25例、肺动脉瓣下室间隔缺损6例。手术采用胸骨正中切口,同期行主动脉缩窄及室间隔缺损手术矫治。本组患儿均应用选择性脑灌注加下半身停循环。结果本组患儿围手术期死亡2例。余29例患儿术后随访3~20个月,恢复可。结论主动脉缩窄合并室间隔缺损可在婴儿期手术,选择胸骨正中切口一期手术可同时矫治主动脉弓发育不良。选择性脑灌注加下半身停循环可以有效保护脑和重要脏器。

Objective To summarize and review the surgical repair of coarctation of the aorta(Coa. Ao) with ventricular septale defect(VSD) in one stage.Methods From January 2008 to December 2016,31 infants diagnosed aortic coarctation with VSD underwent surgical treatment.Mean age of the patients was 4.0 months, with a range from 1 month to 6 months.Mean body weight was 5.2 kg, with a range from 3.0 to 6.5 kg. In all 31 patients of one-stage operation through median sternotomy, selective cerebral perfusion with deep hypothemia and circulatory arrest in lower body(RCP) was used in all patients. Results There were 2 cases postoperative death. One infant died of serious low cardiac output syndrome who was 1 month of age and 3.0 kg in weight, the other one who assosiated with hypolasia of aortic arch dead of severe infection after 6 days postoperation. The other 29 patients were followed up from 3 months to 20 months and the results were satisfactory. Conclusion One-stage surgeries through median stemotomy for aortic coarctation with VSD have satisfactory short-term results in infants. Selective cerebral peusion(RCP) with deep hypothemia and circulatory arrest in lower body can protect the brain and other vital organs.