Yasui手术纠治主动脉弓中断合并室间隔缺损以及主动脉瓣狭窄或闭锁

Yasui procedure for surgical repair of interruption of aortic arch and ventricular septal defect associated with aortic stenosis or aortic atresia

目的总结Yasui手术治疗主动脉弓中断合并室间隔缺损(IAA/VSD)以及主动脉瓣狭窄(AS)或闭锁(AA)的临床经验。方法回顾2014年12月至2019年12月4例行Yasui手术纠治的IAA/VSD/AS(AA)患儿,AS 3例,AA 1例。年龄10天~25个月,体质量2.5~10 kg。A型IAA 1例,B型IAA 3例。主动脉瓣环直径1.9~4.3 mm,Z值-6.7~-3.6,升主动脉直径2.6~5.8 mm,Z值-5.4~-2.6。左心室舒张期末径Z值3.6±2.6,左心室收缩期末径Z值3.6±2.9。结果4例患儿均顺利完成Yasui手术,3例为一期Yasui手术,1例为二期Yasui手术,无手术死亡,体外循环128~283 min,主动脉阻断98~171 min。术后呼吸机使用93~296 h,监护室滞留7~25天,住院18~39天。术后随访8~92个月,无死亡,心功能Ⅰ级3例,Ⅱ级1例,超声心动图显示无左心室流出道狭窄。结论Yasui手术可以作为双心室纠治IAA/VSD/AS(AA)的手术方案选择之一,早期手术疗效良好。

Objective To study the surgical results of Yasui procedure for interruption of aortic arch and ventricular septal defect(IAA/VSD)associated with aortic stenosis(AS)or aortic atresia(AA).Methods A retrospective study was performed on all 4 children with IAA/VSD/AS(AA)that underwent a Yasui procedure from Dec 2014 to Dec 2019.Three patients had AS,and 1 patient had AA.The age was from 10 days to 25 months and the weight was from 2.7 kg to 10 kg.The type of IAA was type A in 1 and type B in 3.The diameter and Z value of the aortic annulus were 1.9-4.3 mm and-6.7--3.6.The diameter and Z value of the ascending aorta were 2.6-5.8 mm and-5.4--2.6.The mean Z value of LVEDD and LVEDS was 3.6±2.6 and 3.6±2.9 resparately.Results All 4 patients survived after the Yasui procedure.Three patients underwent primary repair and 1 patient underwent staged repair.CPB time was 128-283 min and aortic cross-clamping time was 98-171 min.Ventilation time was 93-296 h,and ICU and hospital length of stay was 7-25 days and 18-39 days.Follow-up was complete in all patients from 8 to 92 months,and there was no late death.All the patients were in good biventricular function with NYHA gradeⅠin 3 and NYHA gradeⅡin 2 patients.No residual left ventricular outflow tract obstruction was detected.Conclusion The Yasui procedure can be an option for patients with IAA/VSD/AS(AA)and good developed left ventricle and can achieve good early surgical results.