房室隔缺损的手术治疗

Surgical treatment of atrioventricular septal defect

目的 总结 31例房室隔缺损 (atrioventricularseptaldefect,AVSD)手术治疗经验。方法 31例中部分型 (PAVSD) 11例 ,中间型 (MAVSD) 5例 ,完全型 (CAVSD) 15例。采用 5 0聚丙烯线往返连续缝合的方法闭合左房室瓣大瓣裂缺。部分病例同时进行左房室瓣或右房室瓣成形术。采用新鲜自体心包片或涤纶片修补原发孔房间隔缺损 ,将冠状窦口隔入右房侧。CAVSD 15例中 ,11例按McGoon“单片法”修补 ,4例用“双片法”修补。结果 PAVSD及MAVSD无手术死亡 ,1例CAVSD根治术后早期死于严重低心排 ,死亡率3 2 %。术后随访左房室瓣中度返流 1例 ,轻度返流 4例。全组病人术后无Ⅲ°房室传导阻滞 ,左室流出道狭窄及房、室缺残余漏。结论 PAVSD及MAVSD如无肺高压、严重左房室瓣返流及左室流出道狭窄 ,手术可在 1～ 2岁进行 ,否则应尽早手术。而CAVSD由于大量左向右分流和房室瓣返流 ,大多数患儿 6～ 12个月即出现肺血管阻塞性病变 ,应在肺血管病变发生前行根治术。

Objective To review the experience of surgical treatment of atrioventricular septal defect(AVSD).Methods From January 1993 to October 2003,31 patients with AVSD were diagnosed and divided into partial(11),medial(5) and complete(15) AVSD.All of them underwent surgical treatment under extracoporeal circulation.The cleft of mitral valve was sutured in running by 5 0 prolene.Partial cases were made mitral or tricuspid annuloplasty at the same time.Fresh autologous pericardial patch was utilized to repair primary atrial septal defect.The coronary vein sinus was in the right side after repairement.11 of the complete AVSD cases were repaired according McGoon's “single patch”,and 4 used “two patches”.Results Only one patient with CAVSD died early post operation,caused by low cardiac output syndrome.The mortality was 3.2%.There was mild mitral insufficiency in 4 patients and middle in one.Conclusion PAVSD and MAVSD with pulmonary hypertension,serious mitral insuffiency and left ventricular outlet stenosis must be operated before 1～2 years old.CAVSD must be operated before 3～6 months.