小儿室间隔缺损伴主动脉瓣关闭不全147例诊治体会

147 cases of Ventricular Septal Defect with Aortic Valve Insufficiency in Children

目的 通过临床、心血管造影和手术资料分析14 7例室间隔缺损 (VSD)并主动脉瓣关闭不全 (AI)的诊治体会。方法 年龄 5个月至 15岁 (平均 7 60± 4 12岁 ) ,均经病史、体检、心电图、X线胸片、二维超声心动图及心血管造影诊断。行VSD关闭术 91例 (61 90 % ) ,VSD关闭加主动脉瓣成形术 (AVP) 3 1例 (2 1 0 8% ) ,VSD关闭加主动脉瓣换瓣术 2 5例 (17 0 2 % )。结果 治愈 13 7例 (93 19% ) ,好转 6例(4 0 8% ) ,死亡 4例 (2 73 % )。结论 干下型VSD一旦确诊应尽早手术。膜周型VSD也需超声密切随访发现AI也应尽快手术。无AI者在学龄期也应手术治疗。

Objectives To review 147 cases diagnosed as ventricular septal defect (VSD) combined with aortic valve insufficiency (AI) through the clinical manifestations, the results of angiocardiography and surgical operations. Methods Age ranged from 5 months to 15 years (mean, 7 60±4 12 years). All cases had been diagnosed by history, physical examination, chest roentgenogram, two-dimensional echocardiogram and angiocardiography. In this group, 91 patients (61 90%) underwent the procedure of VSD closure, 31(21 08%) had aortic valvuloplasty (AVP) simultaneously, and 25(17 02%) were performed VSD closure plus aortic valve replacement (AVR). Results Among the 147 patients, 137 (93 19%) have fully recovered, 6(4 08%) were improved, and 4 patients died (2 73%). Conclusions As soon as being diagnosed as subarteriol VSD, surgical intervention should be recommended at an early date. The cases with perimembranous VSD also need close follow up. Once AI occous, operation should be taken in time. The case without AI ought to accept treatment during school age.