NING Yan song,ZHANG Gong,Surgical management of aortic arch obstruction associated with cardiac anomalies in infants.[J].Journal of Clinical Pediatric Surgery,2010,9(06):407.
婴儿主动脉弓阻塞病变的外科治疗
- Title:
- Surgical management of aortic arch obstruction associated with cardiac anomalies in infants.
- Keywords:
- Aortic Arch Syndromes; Aortic Coarctation; Abnormalities/SU; Infant
- 文献标志码:
- A
- 摘要:
- 目的总结8年来56例婴儿主动脉弓阻塞病变的外科治疗经验。方法2001年5月至2009年6月，本院采取经正中切口一期矫治婴儿主动脉弓阻塞病变56例，其中男32例，女24例；年龄16 d至11个月；体重2.3～7.3kg；主动脉弓中断A型22例，B型3例；主动脉缩窄31例。合并室间隔缺损（VSD）及动脉导管未闭（PDA）55例，房间隔缺损（ASD） 6例，右室双出口（DORV)1例，完全性大动脉转位(TGA)1例。均采取经胸骨正中切口深低温停循环下一期矫治手术，采用降主动脉与主动脉弓端端吻合41例，端侧吻合前壁自体心包片加宽弓成形15 例。对合并圆锥部VSD者，为避免远期左室流出道梗阻采用0.4mm GoreTex补片Luciani法修补VSD。结果围术期死亡2例，病死率3.57%；出现喉返神经损伤2 例，跨主动脉弓压差3例，均<20 mmHg。54例存活患儿随访4个月至8年，生长发育良好，无远期主动脉狭窄及左室流出道梗阻，无神经系统并发症。多普勒超声测定跨修复点压力阶差(1.5±0.7)kPa，较术前(6.7±2.3)kPa，显著降低(t=2.51，P<0.05)。结论婴儿主动脉弓阻塞合并心内畸形宜早期手术治疗，经胸骨正中切口一期矫治手术安全有效。
- Abstract:
- ObjectiveTo summarize the experience of onestage repair of aortic arch obstruction associated with cardiac anomalies.MethodsBetween January 2001 and June 2009, 56 infant cardiac patients underwent onestage correction of interrupted aortic arch ( IAA, 25 cases) and coarctation of the aorta ( COA, 31 cases).All procedures were median sternotomy under cardiopulmonary bypass. The aortic arch reconstruction were endtoend anastomosis between the descending aorta and the arch in 41, endtoside anastomosis in 15, and ventricular septal defect was repaired with GoreTex patch. ResultsThere were 2 death ( overall mortality 3.57%) . The recurrent laryngeal nerves injuries in 2, the peaktopeak systolic pressure of aortic arch in 3(all lower than 20mmHg).All survivors were followed up for 4 month to 8 year. They were asymptomatic and developing normally. No later restenosis of anastomosis occurred and severe neurological complications were found.Conclusion Onestage complete correction of IAA and COA with cardiac anomalies through median sternotomy yields excellent intermediate surgical results.
参考文献/References:
1张玉龙,李仲智,李晓峰,等.主动脉弓阻塞合并心脏畸形18例的一期矫治\[J\].中国心血管病研究杂志,2007,5(1):13—15.2Isomatsu Y,Imai Y,Shin’oka T,et al.Coarctation of the aorta and ventricular septal defect:should we perform a singlestage repair\[J\].J Thorac Cardiovasc Surg,2001,122(3):524—528.3Haas F,Goldberg CS,Ohye RG,et al.Primary repair of aortic arch obstruction with ventricular septal defect in preterm and low birth weight infants\[J\].Eur J Cardiothorac Surg,2000,17(6):643—647.4周燕萍,史珍英,蔡及明,等.主动脉缩窄手术与年龄的探讨\[J\].上海第二医科大学学报,2004,24:853—855.5陈欣欣,张镜芳,庄建,等.经胸骨正中切口一期矫治小儿主动脉缩窄及合并畸形\[J\].中华胸心血管外科杂志,2006,22(6):374—376.6Alfred EW,Hossein J.Is extended arch aortoplasty the operation of choice for infant aortic coarctationResults of 15 years’ experience in 181 patients\[J\].Ann Thorac Surg,2004,77:1353—1358.7Gail EW,Cheryl AN.Extended resection and endtoend anastomosis for aortic coarctation in infants:results of a tailored surgical approach\[J\].Ann Thorac Surg,2005,80:1453—1459.8Thomson DJ,Mulpur A.Outcome after extended arch repair for aortic coarctation\[J\].Heart,2006,9:90—94.9Toro-Salazar OH,Steinberger J,Thomas W,et al.Longtern followup of patients after coarctation of aorta repair\[J\].Am JCardiol,2002,89(5):541—547.10Corno AF,Botta U,Hurni M,et al.Surgery for aortic coarctation:a 30 years experience\[J\].Eur J Cardiothorac Surg,2001,20(6):1202—1206.11Ilic′S,Vukovic′I,Hercog D,et al. Surgery for coarctation of the aortic in infants younger than three months\[J\].Srp Arh Celok Lek,2004,132(suppl 1):27-33.
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