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目的总结婴幼儿主动脉缩窄伴心血管畸形纠治的手术方法和临床经验。方法回顾性分析2002年1月至2009年5月,我院采用胸骨正中切口Ⅰ期手术纠治的35例主动脉缩窄伴心血管畸形患儿,手术时年龄1～35个月,体重3.5～12.5 kg,平均(5.2±2.2)kg。主动脉缩窄位于导管前23例,邻近动脉导管处12例;其中3例伴主动脉弓发育不良,15例伴有动脉导管未闭3,0例伴有室间隔缺损,10例伴有房间隔缺损,3例伴有右室流出道梗阻2,例伴有法洛四联征。结果本组35例中,2例死亡,余33例术后恢复良好。随访6个月～7年,1例半年后经超声心动图检查和螺旋CT造影检查发现吻合口处血栓形成,家属放弃治疗,未进一步治疗。3例经心脏多普勒超声检查发现术后再狭窄,继续随访中,其余经超声心动图检查无假性动脉瘤或主动脉再狭窄。结论术前心功能差和术后长时间机械呼吸是手术死亡的高危因素。术后再狭窄是婴幼儿主动脉缩窄患者主要的晚期并发症。采用胸骨正中切口Ⅰ期手术纠治主动脉缩窄伴室间隔缺损,可同时纠治并发的主动脉弓部发育不良,降低了残余梗阻的发生率。Ⅰ期纠治还具有明显降低手术费用,减少患儿二次手术痛苦的优点。
Objective To summarize the surgical methods and clinical experience of the treatment of infantile aortic constriction with cardiovascular malformations. Methods From January 2002 to May 2009, 35 cases of aortic constriction and cardiovascular malformations underwent revision surgery from January 2002 to May 2009 in our hospital. The patients were aged 1 to 35 months and weighed 3.5 ~ 12.5 kg, with an average of (5.2 ± 2.2) kg. Aortic constriction was located in the front of the catheter in 23 cases, adjacent to the ductus arteriosus in 12 cases; 3 cases with aortic arch dysplasia, 15 cases with patent ductus arteriosus 3,0 cases with ventricular septal defect, 10 cases with atrial septal defect , 3 cases with right ventricular outflow tract obstruction 2, with associated tetralogy of Fallot. Results 35 cases in this group, 2 patients died, more than 33 cases recovered well. Followed up for 6 months to 7 years, 1 case after six months after echocardiography and spiral CT angiography showed thrombosis at the anastomotic site, family members to give up treatment, without further treatment. Three cases of restenosis after Doppler echocardiography were observed. During the follow-up, the remaining echocardiography was performed without pseudoaneurysm or aortic restenosis. Conclusions Preoperative cardiac dysfunction and prolonged mechanical respiration after surgery are the risk factors for mortality. Restenosis after surgery is a major late complication of infantile aortic constriction. The surgical treatment of aortic stenosis with ventricular septal defect by mid-incision of the mid-sternotomy can simultaneously rectify the dysplasia of concurrent aortic arch and reduce the incidence of residual obstruction. Stage I correction also has significantly reduced the cost of surgery and reduce the advantages of secondary surgical pain in children.