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目的探讨儿童冠状动脉起源于肺动脉的外科治疗方法及疗效。方法冠状动脉起源于肺动脉患儿16例,其中左冠状动脉起自肺动脉(anomalous origin of the left coronary artery from the pulmonary artery,ALCAPA)14例,右冠状动脉起自肺动脉(anomalous origin of the right coronary artery from the pulmonary artery,ARCAPA)2例,均行冠状动脉起源异常矫治手术,13例异常起源冠状动脉与升主动脉直接移植吻合,3例行Takeuchi术;对4例合并二尖瓣重度反流者行二尖瓣成形术,1例左心室室壁瘤行室壁瘤切除。术后随访6个月观察治疗效果。结果本组无围手术期死亡病例,住院期间无并发症发生;术后6个月时,患儿心胸比(0.50±0.01)、左心室舒张末期内径[(33.4±4.3)mm]较术前[0.57±0.08、(39.6±8.1)mm]明显减小(P<0.05),左室射血分数[(0.66±0.07)%]、短轴缩短率(0.37±0.01)较术前[(0.57±0.15)%、(0.31±0.09)]明显增加(P<0.05),二尖瓣轻度反流5例。结论双冠状动脉解剖矫治是治疗冠状动脉起源于肺动脉的常用方法,近期疗效良好。
Objective To investigate the surgical treatment of pediatric coronary artery originated from pulmonary artery and its curative effect. Methods Totally 16 children with coronary artery originated from the pulmonary artery, including 14 patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). The right coronary artery originated from the anomalous origin of the right coronary artery From the pulmonary artery, ARCAPA) 2 cases, all underwent coronary angioplasty, 13 cases of abnormal origin of coronary artery and ascending aorta were directly transplanted anastomosis, 3 cases of Takeuchi surgery; 4 cases of severe mitral regurgitation Mitral angioplasty, 1 case of left ventricular aneurysm wall aneurysm resection. Follow-up 6 months after treatment to observe the effect. Results There were no perioperative deaths and no complication during hospitalization. Heart rate ratio (0.50 ± 0.01) and left ventricular end-diastolic diameter [(33.4 ± 4.3) mm] at 6 months after operation were significantly higher than those before operation (0.57 ± 0.08 and (39.6 ± 8.1) mm], the left ventricular ejection fraction [(0.66 ± 0.07)%], short axis shortening (0.37 ± 0.01) ± 0.15%, (0.31 ± 0.09)], and mild mitral regurgitation in 5 cases (P <0.05). Conclusion Anatomical treatment of double coronary arteries is a commonly used method for the treatment of coronary arteries originating from pulmonary arteries. The recent curative effect is good.