成人心房间隔缺损及肺高压的手术治疗

Operation for Adult Interatrial Septal Defect With Pulmonary Hypertension

目的 报告 4 9例成人心房间隔缺损 (房缺 )伴有肺高压的手术治疗 ,并评估其结果。方法 采用传统方法对各类型房缺进行手术。采用单向活瓣补片修补 2例伴有严重肺动脉高压的房缺。术中同时对伴有显著二尖瓣与三尖瓣关闭不全者进行了瓣环成形术。结果 4 9例全部治愈 ,无 1例死亡。术后 1月、5月复查 ,心脏大小正常 ,心电图正常 ,血气分析正常 ;心功能Ⅰ级 4 7例 ,心功能Ⅱ级 2例。结论 成人房缺且合并有肺高压者应手术治疗。术中对合并显著二尖瓣与三尖瓣病变的处理 ,是术后心功能恢复的关键。单向瓣修补伴肺高压的房缺 ,降低了手术并发症与死亡率 。

Objective To report 49 cases of adult interatrial septal defect with pulmonary hypertension operated and to evaluate their results.Method Most of those cases were repaired with conventional operative procedures,but 2 cases among them with severe pulmonary hypertension were repaired with one-way valvular patch.Those with mitral or tricuspid remarkable regurgitation,were repaired with annuloplastic procedure at the same time.Results There were no operative death,and followed up for one to five months,the heart size,ECG and the data of blood gas analysis were retuned into normal value.Heart function of 47 case was raised to Ⅰ class(NYHA),and 2 case to Ⅱ class.Conclusions Operation for adult interatrial septal defect especially with pulmonary hyperteasion is highly indicated.Treatment of mitral or tricuspid regurgitation remarkably at the same time is important for recovery of cardiac function.One-way valvular patch used to repair ASD with severe pulmonary hypertension could reduce complication and mortality,so it is an effective procedure adapted.