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目的 观察复杂心脏畸形右室双出口外科治疗效果 .方法 1991- 12 /1997- 0 5我院对 2 3例 (男 17,女 6 )右室双出口患者进行根治手术 ,年龄 4mo～ 16岁 ( 6 .8± 3.6 )岁 .病理解剖均为两大动脉起于右心室 ,主动脉瓣和二尖瓣无纤维连续性 .其中 SDD型 18例 ,SDL 型 3例 ,IL L 型 1例 ,IDD型 1例 ,室缺位于主动脉下 12例 ,肺动脉下 3例 ,其中 Taussig- Bing畸形 2例 ,靠近两大动脉开口 5例 ,远离两大动脉开口 3例 .有肺动脉狭窄 18例 ,无肺动脉狭窄伴肺动脉高压 5例 ,合并房缺 15例 ,动脉导管未闭 4例 ,左上腔静脉畸形 5例 ,右室流出道横跨粗大冠状动脉 5例 ,合并肺动脉内折断之右心导管异物 1例 .结果 手术阻断升主动脉时间为 46 .8～ 12 0 .3 ( 72 .4± 18.5 )min,体外循环时间为 71～ 184.7( 12 0 .2± 2 7.6 ) min.术中应用心内隧道 16例 ,心内管道 7例建立室缺肺动脉口连续性 ,应用带瓣管道 5例 ,带单瓣补片 7例 ,单纯补片 11例加宽右室流出道 .对 Taussig- Bing畸形应用改良 Patrick- Mc Goon心室内调转手术 .全组手术死亡 2例 ,死亡率为 8.7% ,心功能均恢复到I级 .结论 右室双出口外科矫治可获得较好的效果
Objective To observe the effect of surgical treatment of double outlet of right ventricle in patients with complicated cardiac malformation.Methods From 1991 to December 1997, the patients underwent radical surgery in 23 patients (male 17, female 6) with right ventricular outlet, aged 4 to 16 years 6 .8 ± 3.6) years old.Pathological anatomy were two arterial originated in the right ventricle, aortic valve and mitral valve without fibrous continuity.Among them SDD 18 cases, SDL 3 cases, IL L 1 cases, IDD 1 case, 12 cases of atrial septal defect under the aorta, 3 cases under the pulmonary artery, of which Taussig-Bing malformation in 2 cases, close to the two major artery opening in 5 cases, away from the two major artery opening in 3. There are 18 cases of pulmonary stenosis, pulmonary stenosis with pulmonary artery 5 cases of high pressure, combined atrial septal defect in 15 cases, patent ductus arteriosus in 4 cases, left superior vena cava malformation in 5 cases, right ventricular outflow tract across the large coronary artery in 5 cases, combined with pulmonary artery in the right heart catheterization in 1 case.Results The time of ascending aorta occlusion was 46.8 ~ 120.3 (72.4 ± 18.5) min, and the time of cardiopulmonary bypass was 71 ~ 184.7 (122 ± 2 7.6) min. Sixteen patients underwent intracardiac tunneling Seven cases of intracardiac catheterization established pulmonary venous insufficiency continuity. Five cases with valved catheter were used Flap patch in 7 cases and simple patch in 11 cases widened the right ventricular outflow tract.A modified Patrick-Mc Goon modified ventricular tachycardia procedure was used in Taussig-Bing deformity.All patients died in 2 cases with a mortality rate of 8.7% and heart function Recovery to level I. Conclusion Right outlet double outlet surgical correction can get better results