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目的总结40例儿童完全性房室隔缺损(comple atrlovcntricular septal defect,CAVSD)的外科治疗经验,以提高手术治疗效果。方法RastelliA型32例,B型1例,C型7例。40例CAVSD(不包括过渡型)中22例采用单片心包补片法纠治,18例用双片法纠治。结果手术死亡3例,死亡率7.5%。死亡原因:1例因重度肺动脉高压出现肺动脉高压危象及心肺功能衰竭;1例III度房室传导阻滞及严重低心排;1例合并主动脉缩窄及右室双出口术后12天死于感染性心内膜炎。远期死亡1例,为二尖瓣返流并发肺炎心力衰竭。结论CAVSD易在早期并发梗阻性肺血管疾病,手术应在3～12个月内进行。手术要点除完善闭合房室隔缺损外,特别注意恢复二尖瓣功能;术后处理应严格防治肺动脉高压,控制血压,以减轻二尖瓣再损伤和反流。
Objective To summarize the experience of surgical treatment of complete atrovertictricular septal defect (CAVSD) in 40 children in order to improve the effect of surgical treatment. Methods Rastelli A type in 32 cases, B type in 1 case, C type in 7 cases. Twenty-two cases of CAVSD (excluding transitional type) were treated by single pericardial patch method and 18 cases were treated by two-slice method. Results 3 cases died of surgery, the mortality rate was 7.5%. Causes of death: 1 case of pulmonary hypertension due to severe pulmonary hypertension crisis and cardiopulmonary failure; 1 case of III degree atrioventricular block and severe low cardiac output; 1 case of aortic constriction and right ventricular double outlet after 12 days Died of infective endocarditis. Long-term death in 1 case, mitral regurgitation complicated with pneumonia and heart failure. Conclusions CAVSD is easy to be associated with early obstructive pulmonary vascular disease. The operation should be performed within 3 to 12 months. In addition to improving the main points of surgery, atrial septal defect, with special attention to restore mitral valve function; postoperative management should be strictly controlled pulmonary hypertension, blood pressure control to mitigate mitral regurgitation and reflux.