心脏不停跳心内直视手术在婴儿先天性心脏病矫治中的应用

Open-heart surgery with heart beating on infants with congenital heart diseases

目的 总结我院 1998年 1月至 2 0 0 2年 10月期间 13 7例婴儿先天性心脏病在心脏跳动下实施外科治疗的体会。方法 在低温体外循环下 ,不阻断升主动脉 ,保持心肌有氧血供 ,将左房引流管经二尖瓣口置入左室 ,持续吸引 ,并使左室腔与大气相通。完成心内畸形矫治后 ,采用综合序贯排气法排除心腔气体。结果 全组死亡 5例 ,死亡率 3 6%。无因体循环气栓而致认知和肢体功能障碍者 ,无气管切开者。

Objective To summarize the experience in open heart surgery with heart beating on 137 infants with congenital heart diseases (CHD) between January 1998 and October 2002. Methods Open heart surgery was performed with hypothermic cardiopulmonary bypass, ascending aorta not clamped, and myocardium infused continuously by oxygenated blood. Left atrial drainage catheter was approached into the left ventricular chamber (LVC) through mitral valve orifice, resulting in LVC opened to the room. Complete deairing of the left and right ventricular air was performed by integrated sequential deairing method after correction of intracardiac anomaly. Results The mortality was 3.6% (5/137). No patient with postoperative disability of cognition and movement due to systemic air embolism was found, and all patient were free from tracheotomy. Conclusion Open heart surgery with heart beating can be performed safely and reliably on infants with simple CHD.