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目的:总结婴儿发绀型复杂先天性心脏病(先心病)患儿,行双向上腔静脉肺动脉吻合术病例的临床特点及预后分析。方法:2006年3月至2013年12月,36例单心室、肺动脉闭锁等复杂先心病畸形患者均接受了双向上腔静脉肺动脉吻合术。其中体外循环下8例,非体外循环下28例。男性24例,女性12例。平均年龄(0.66±0.21)岁,体表面积(0.16±0.05)m2,经皮血氧饱和度(73±9)%,术前肺动脉压(12.19±3.68)mm Hg(1mm Hg=0.133k Pa)。结果:手术死亡2例,术后出现并发症5例(胸腔积液4例,乳糜胸1例)。术后肺动脉压(17.74±3.62)mm Hg,经皮血氧饱和度(84±16)%,手术时间(173.55±42.16)分钟。结论:对于1岁以内的婴儿发绀型复杂先心病患儿,双向上腔静脉肺动脉吻合术是一种简单、可靠的手术方式。对于难以解剖根治或I期Fontan手术的发绀类肺血少复杂先心病患儿,此手术可缓解患儿的缺氧状况以及改善肺血管发育,为以后手术创造了机会。
OBJECTIVE: To summarize the clinical features and prognosis of infants with complicated cyanotic complex congenital heart disease (CHD) undergoing bilateral superior vena cava pulmonary artery anastomosis. METHODS: From March 2006 to December 2013, 36 patients with complex congenital heart disease such as single ventricle and pulmonary atresia underwent bi-directional superior vena cava pulmonary artery anastomosis. Among them, 8 cases under cardiopulmonary bypass, 28 cases under off-pump. 24 males and 12 females. The mean age was (0.66 ± 0.21) years old, body surface area (0.16 ± 0.05) m2, percutaneous oxygen saturation (73 ± 9)%, preoperative pulmonary artery pressure (12.19 ± 3.68) mm Hg (1mm Hg = 0.133kPa) . Results: Two cases died of surgery, and 5 cases had postoperative complications (pleural effusion in 4 cases and chylothorax in 1 case). Postoperative pulmonary pressure (17.74 ± 3.62) mm Hg, percutaneous oxygen saturation (84 ± 16)%, operative time (173.55 ± 42.16) minutes. CONCLUSIONS: Bidirectional superior vena cava pulmonary artery anastomosis is a simple and reliable surgical procedure for children with cyanotic complex congenital heart disease within 1 year of age. For children with difficult congenital radical or type I Fontan surgery cyanotic pulmonary blood less complex congenital heart disease, this operation can relieve hypoxia in children and improve pulmonary vascular development, creating opportunities for future surgery.