小儿房间隔缺损30例临床分析

Clinical analysis of 30 cases of atrial septal defect (ASD) in children

目的 总结小儿房间隔缺损 (atrial septal defect,ASD)外科治疗的特点。方法 统计分析 30例小儿 ASD临床资料和术前诊断、手术纠治及术后处理的体会。结果 30例小儿 ASD:单纯继发孔 ASD15例 (合并肺高压 9例 ) ,ASD长径均在 1cm以上 ;合并其他畸形 15例 (5 0 % ) ,其中合并肺动脉瓣狭窄 6例 (2 0 % )、肺静脉搏异位引流 4例 (13.3% )、原发孔 ASD 4例 (13.3% )、三房心 1例 (3.3% ) ;术后并发症 4例 ,其中心律紊乱 3例(10 % )。结论 临床小儿 ASD有下列特点 :(1)单纯继发孔 ASD一般较大、分流量多、肺高压出现早 ;常合并有其他畸形 ,如肺静脉异位引流、肺动脉瓣狭窄、三房心或是原发孔 ASD;(2 )手术纠治是安全、可靠的 ,关键是彻底修补ASD防止残余漏并妥善处理合并畸形 ;(3)术后处理应针对肺高压、心功能和手术情况防治肺高压危象、心衰。

Objective To review the characters of the surgical treatment of ASD in 30 children.Methods The clinical data and the surgical outcome in 30 cases of ASD in children were analysed.Results Thirty patients with ASD included 15 cases of simple secondary foramen complicated with pulmonary hypertension in 9 cases.The others were associated with other cardiovascular abnormalities(50%)The postoperative complications were found in 4 patients including 3 patients with arrhythmia(10%).Conclusions The clinical characters of ASD in children are:(1)The ASD is usually long and the pulmonary hypertension occurred early.Some patients were complicated with other cardiovascular abnormalities such as abnomal pulmonary venous connection(APVC),pulmonary valve stenosis(PS),cor triatriatum of atrioventricular septal defect and so on.(2)The surgery is satisfactory.The important factor is exact reparement of the ASD and the cardiovascular abnormalities.(3)Proper post opevative management is an important factor fluencing surgical outcome.