上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (9): 1263-.doi: 10.3969/j.issn.1674-8115.2011.09.011

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肌部多发室间隔缺损伴心脏畸形的心内直视镶嵌封堵治疗

张海波, 徐志伟, 刘锦纷, 苏肇伉, 丁文祥   

  1. 上海交通大学 医学院附属上海儿童医学中心心胸外科, 上海 200127
  • 出版日期:2011-09-28 发布日期:2011-09-27
  • 作者简介:张海波（1964—）, 男, 主任医师, 博士, 硕士生导师；电子信箱: zhanghaiboscmc@163.com。

Hybrid approaches under direct vision in management of multiple muscular ventricular septal defects with associated cardiac malformations

ZHANG Hai-bo, XU Zhi-wei, LIU Jin-fen, SU Zhao-kang, DING Wen-xiang   

  1. Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2011-09-28 Published:2011-09-27

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摘要：

目的 观察心内直视镶嵌封堵肌部多发室间隔缺损并同期纠治心脏伴发畸形的临床疗效。方法 40例肌部多发室间隔缺损伴其他心脏畸形患者，于体外循环下行心内直视镶嵌封堵室间隔缺损并同期纠治心脏畸形，分析手术结果与随访情况。结果 手术死亡3例，病死率7.5%。3例患者术后发生肺动脉高压危象，经治疗痊愈；所有患者均无明显残余分流。术后随访6个月～3年，无死亡病例；17例封堵器边缘残留少量左向右分流，3例二尖瓣整形残留轻度反流。结论 心内直视镶嵌封堵肌部多发室间隔缺损操作简便、安全，可缩短体外循环时间，并同期纠治心脏合并畸形，中长期疗效较佳。

关键词: 镶嵌封堵, 心内直视, 肌部多发室间隔缺损, 伴发心脏畸形

Abstract:

Objective To observe the clinical outcomes of hybrid approach under direct vision in management of multiple muscular ventricular septal defects with associated cardiac malformations. Methods Forty patients with multiple muscular ventricular septal defects and associated cardiac malformations were enrolled, and hybrid approach under direct vision and cardiac malformation correction were performed with cardiopulmonary bypass. The results of operation and follow up were analyzed. Results Three patients died during operation, with the mortality of 7.5%. Pulmonary hypertension crisis occurred in 3 patients, and all were cured. No obvious residual shunt was observed in all patients. Patients were followed up for 6 months to 3 years, and no death occurred. Clinically insignificant residual shunt took place in 17 patients, and mild residual regurgitation was observed in 3 patients undergoing mitral valvuloplasty. Conclusion Hybrid approach under direct vision in management of multiple muscular ventricular septal defects, which can shorten the time of cardiopulmonary bypass and correct associated cardiac malformations at the same time, is convenient and safe, and may yield favorable mid-term and long-term outcomes.

Key words: hybrid approach, direct vision, multiple muscular ventricular septal defects, associated cardiac malformation