右心室双出口的外科治疗

Surgical treatment of double outlet of right ventricle

目的探讨右心室双出口的手术治疗效果。方法对 31例右心室双出口患者手术的临床资料分析。主动脉瓣下室间隔缺损 (VSD)型 2 3例 ,肺动脉瓣下VSD型 2例 ,两大动脉瓣下VSD型 5例 ,远离两大动脉VSD型 1例。有肺动脉狭窄者 2 1例 ,肺动脉高压者 7例。采用左心室 主动脉心内隧道连接 2 6例 ,左心室 主动脉心内隧道并右心室 肺动脉心外同种带瓣主动脉管道连接 2例 ,全腔静脉 肺动脉连接 1例 ,双向Glenn手术 2例。右心室流出道重建采用直接缝合 1例 ,自体心包片加宽 9例 ,跨瓣补片扩大至左右肺动脉分叉或一侧肺动脉 14例 ,同种带瓣主动脉血管片连接 2例。结果手术死亡 3例。手术非致死并发症 9例治愈出院。随访无远期死亡 ,效果良好。结论根据右心室双出口的解剖特点和不同类型 ,选择不同的根治或姑息手术方式 ,保证重建的左、右心室流出道畅通 ,是手术成功的关键技术。

Objective To evaluate the results of surgical treatment of double-outlet of right ventricle(DORV). Methods The clinical data of 31 cases with double outlet of right ventricle were analyzed. The ventricular septal defect(VSD) was at subaortic in 23 cases, subpulmonary in 2, doubly committed in 5, and noncommitted in 1. There were pulmonary stenoses in 21 cases, pulmonary artery hypertension in 7. The surgical strategies in DORV included left ventricle aorta intraventricular tunnel connection in 26 patients, left ventricle-aorta intraventricular tunnel and right ventricle-pulmonary artery extracardial cryopreserved aoric homografts valved tube repaired in 2, extracardiac conduit total cavopulmonary artery connection in 1,bi-directional Glenn in 2. The right ventricular outflow tract reconstructions were done by incision closed in 1 case, using a patch of autologus pericardium in 9, a transannular patch of autologus pericardium in 14, cryopreserved aortic homografts valved in 2. Results There were 3 operative deaths. 9 patients were discharged from hospital when non-fatal complications were cured. There was no long-term death, with better results. Conclusion Depending upon anatomic features and different forms of hypoplasia of DORV, the radical operation and palliative operation can be achieved with excellent clinical outcome. Reconstruction of the left and right ventricular outflow tract is essential procedure to the surgical success.