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目的总结动脉导管未闭﹙PDA﹚合并其他心血管畸形的手术治疗经验,以提高手术治愈率。方法 1999年9月至2007年2月共收治动脉导管未闭﹙PDA﹚合并其他心血管畸形87例,男36例,51例,年龄7月至14岁,其中合并室间隔缺损﹙VSD﹚47例,法洛氏四联症﹙TOF﹚12例,房间隔缺损﹙ASD﹚9例,肺动脉瓣狭窄﹙PS﹚8例,二尖瓣关闭不全﹙MI﹚5例,主动脉缩窄﹙CoA﹚4例,部分型房室间隔缺损﹙PVASD﹚和部分型肺静脉异位引流﹙PAPVC﹚各1例。合并肺动脉高压共42例。全组3例PDA合并VSD、CoA:1例分期手术,先行PDA结扎切断缝合及CoA矫治术﹙左锁骨下动脉瓣翻转术﹚,术后6个月再行VSD修补术;2例同期行PDA结扎切断缝合、CoA矫治术﹙缩窄段切除,端端吻合术﹚、VSD修补术。余病例均同时行PDA结扎或缝合和其他心血管畸形矫治术。PDA均在心内畸形矫治前予以游离结扎或者经肺动脉切开缝合,其中体外循环转流前结扎22例,转流后结扎33例,转流后切开肺动脉缝合PDA开口32例。结果 2例术后6h、11h分别死于肺动脉高压危象、顽固性低心输出量综合征,死亡率2.4%。术后并发灌注肺综合征2例,毛细血管渗漏综合征2例,肾功能不全、左侧膈神经麻痹、轻度精神异常、伤口愈合延迟各1例。经过积极对症治疗患者均痊愈出院。结论对PDA合并其他心血管畸形的诊断要点、手术原则、采取的方法及防止并发症的细节等足够重视,可以取得满意的手术治愈率。
Objective To summarize the experience of surgical treatment of patent ductus arteriosus (PDA) combined with other cardiovascular malformations in order to improve the cure rate. Methods From September 1999 to February 2007, 87 cases of patent ductus arteriosus (PDA) combined with other cardiovascular malformations were treated, including 36 males and 51 females, aged from July to 14 years. Of them, 47 cases had combined ventricular septal defect (VSD) (TOF) in 12 cases, atrial septal defect (ASD) in 9 cases, pulmonary stenosis (PS) in 8 cases, mitral regurgitation (MI) in 5 cases, aortic constriction (CoA) 4 cases, partial atrioventricular septal defect (PVASD) and partial pulmonary venous drainage (PAPVC) in 1 case. A total of 42 patients with pulmonary hypertension. Three cases of PDA combined with VSD, CoA: one case of staging surgery, the first PDA ligation and suture closure and CoA correction (left subclavian valve flap surgery), 6 months after VSD repair; 2 cases of PDA Ligation and suture closure, CoA correction (narrowing, end anastomosis), VSD repair. The remaining cases were simultaneously PDA ligation or suture and other cardiovascular malformations. PDA were either ligated or percutaneously sutured before the deformity correction in the heart. Among them, 22 cases were ligated before bypass and 33 cases were implanted after bypass, and 32 cases were opened by pulmonary artery sutured PDA after bypass. Results Two patients died of pulmonary hypertension crisis and refractory low cardiac output syndrome respectively at 6h and 11h after operation, with a mortality rate of 2.4%. Postoperative pulmonary perfusion syndrome in 2 cases, 2 cases of capillary leak syndrome, renal insufficiency, left phrenic nerve paralysis, mild mental abnormalities, delayed wound healing in 1 case. After symptomatic treatment of patients were cured and discharged. Conclusions The diagnosis of PDA combined with other cardiovascular malformations, the principle of surgery, methods taken and details of prevention of complications, enough attention, you can get a satisfactory rate of surgical cure.