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目的探讨一个半心室矫治术治疗复杂先天性心脏病的适应证及术式。方法 21例先天性心脏病患儿根据心脏畸形不同分为3组,A组11例为Ebstein畸形或三尖瓣狭窄性病变者,B组4例为右心发育不良患儿,C组6例为其他复杂心脏畸形。3组均在低温体外循环下行心内畸形矫正+上腔静脉-肺动脉吻合术。比较各组体外循环时间、主动脉阻断时间、呼吸机辅助时间、ICU时间和胸腔引流量等。结果 C组体外循环时间、主动脉阻断时间、呼吸机辅助时间、ICU时间较A、B组长,但组间比较差异均无统计学意义(P>0.05);C组术后1~3d胸腔引流总量[(1 148±403)mL/m2]大于A组[(676±518)mL/m2]和B组[(338±175)mL/m2],A、B组比较差异无统计学意义(P>0.05);术后A、B组无死亡病例,C组死亡2例;B组无并发症发生,A组发生心包积液2例、室上性心律失常1例,C组发生感染2例、低心排出量综合征1例;3组术后超声心动图检查均未见上腔静脉肺动脉吻合口狭窄,A组发生三尖瓣少量反流3例及中量反流1例;3组左室射血分数比较差异无统计学意义(P>0.05)。结论一个半心室矫治术可作为右心室结构及功能异常的Ebstein畸形或右心发育不良者理想术式,但对肺动脉发育不良的复杂先天性心脏病需谨慎选择该术式。
Objective To investigate the indications and surgical procedures of a half ventricle correction for complicated congenital heart disease. Methods Twenty-one children with congenital heart disease were divided into three groups according to different cardiac malformations. Eleven patients in group A were patients with Ebstein’s malformation or tricuspid stenosis. Four patients in group B were patients with right-ventricular dysplasia. Six patients in group C For other complex heart deformities. All the 3 groups underwent cardiopulmonary deformity correction + superior vena cava-pulmonary artery anastomosis under hypothermic cardiopulmonary bypass. The time of cardiopulmonary bypass, the time of aortic block, ventilator support time, ICU time and chest drainage were compared. Results The time of extracorporeal circulation, the time of aorta block, ventilator auxiliary time and ICU in group C were longer than those in group A and B, but no significant difference was found between groups (P> 0.05). In group C, The total amount of chest drainage [(1 148 ± 403) mL / m2] was greater than that of group A [(676 ± 518) mL / m2] and group B [338 ± 175 mL / m2] (P> 0.05). There were no deaths in groups A and B and 2 deaths in group C. There were no complications in group B, 2 cases of pericardial effusion in group A, 1 case of supraventricular arrhythmia, group C 2 cases of infection, 1 case of low cardiac output syndrome; 3 cases of postoperative echocardiography showed no superior vena cava pulmonary anastomotic stenosis, A group of tricuspid regurgitation occurred in 3 cases and the amount of reflux 1 Cases; 3 left ventricular ejection fraction difference was not statistically significant (P> 0.05). Conclusion One-and-a-half ventricular surgery is an ideal surgical procedure for Ebstein’s malformation or right-ventricular dysplasia with right ventricular dysfunction. However, this procedure should be carefully selected for complex congenital heart disease with poorly developed pulmonary arteries.