婴儿及新生儿永存动脉干的外科治疗

Surgical efficacy of persistent truncus arteriosus in neonates and infants

目的评估婴儿及新生儿永存动脉干非心外管道的外科手术方法的可行性和临床疗效。方法收集2011年7月至2022年11月广东省妇幼保健院心脏中心手术治疗的12例永存动脉干婴儿的临床资料,其中男7例,女5例;新生儿8例。患儿的中位手术年龄为30(8~201)d,中位体重为3.3(2.8~5.1)kg。所有患儿均行超声心动图及心脏CT检查,按Van Praagh分型:A1型6例、A2型4例、A4型2例。采用自身肺动脉与右室切口上缘缝合或左(右)心耳代替肺动脉后壁,结合带单瓣的牛心包补片重建右室流出道与肺动脉,同时矫治其他心血管畸形。术后常规随访评估疗效。结果所有患儿无手术死亡。术后机械通气时间为(13.8±9.0)d,住院天数为(25.4±11.3)d。随访时间为(61.0±36.4)个月,1例因远端左、右肺动脉狭窄于术后9个月再次手术治疗,其余患儿心功能Ⅰ级或Ⅱ级。结论非心外管道的外科手术治疗婴儿及新生儿永存动脉干是安全有效的,近期和中期的疗效满意。

ObjectiveTo evaluate the feasibility and clinical efficacy of non-conduit surgical repair for persistent truncus arteriosus(PTA)in neonates and infants.MethodsFrom July 2011 to November 2022,12 PTA children were recruited.There were 7 boys and 5 girls.Eight children were neonates.Median operative age was 30(8-201)days and median weight 3.3(2.8-5.1)kg.Echocardiography and enhanced computed tomography(CT)were performed.According to the Van Praagh classification scheme,the clinical types were A1(n=6),A2(n=4)and A4(n=2).Right ventricular outflow tract(RVOT)was reconstructed by suturing directly self-pulmonary and right ventricle incision or indirectly with inserting right or left auricle.At the same time,a bovine pericardial patch with valve was applied and other cardiac anomalies were repaired.ResultsThere was no intraoperative mortality.The mean post-discharge follow-up period was(61±36.4)(2-141)months.One child required a second operation due to distal left and right pulmonary artery stenosis while the remainders achieved cardiac function grade I/II.ConclusionNon-conduit surgical repair for PTA infants is both safe and effective and long-term follow-ups are warranted.