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目的 了解动脉干下型室间隔缺损 (简称干下室缺 )的临床过程 ,恰当掌握手术适应证。方法 总结经手术证实的 14岁以下儿童干下室缺 2 72例 ,观察年龄与肺动脉高压和主动脉瓣病变(主动脉瓣关闭不全、主动脉瓣脱垂、主动脉窦瘤破裂 ) ;室缺大小与肺动脉高压、主动脉瓣病变的关系。结果 (1) 2 72例经胸超声心动图检出干下室缺 2 46例 ,符合率 90 4%。 (2 )随着年龄的增长 ,合并肺动脉高压的几率减少 ,程度减轻。年龄小于 1岁 ,肺动脉高压发生率为 70 % ,7～ 14岁为 2 8%。(3)随着年龄的增长 ,合并主动脉瓣病变有增长趋势 ,但差异无显著性 ,7～ 14岁出现主动脉瓣病变38 7%。 (4 )随着干下室缺的增大 ,发生肺动脉高压的几率、严重程度显著增加 ,干下室缺大于 10mm ,肺动脉高压发生率达 5 2 3%以上。 (5 )随着干下室缺的增大合并主动脉瓣病变的发生率差异无显著性。 (6 )手术方式以补片修补者 2 6 7例 (98 2 % ) ,直接缝合 5例 ,手术治愈 2 6 7例 (98 2 % )、死亡 5例(1 8% )。结论 干下室缺因其解剖特点及血流动力学特点 ,无自然闭合倾向 ,且易合并严重并发症 ,因此该型室缺一经诊断即应早期手术。
Objective To understand the clinical process of inferior vena articular septal defect (referred to as dry space), proper surgical indications. Methods A total of 728 cases of dry-labors under 14 years of age confirmed by surgery were reviewed. Age, pulmonary hypertension and aortic valve disease (aortic valve insufficiency, aortic valve prolapse, and rupture of aortic sinus aneurysm) were observed. Size and pulmonary hypertension, aortic valve disease. Results (1) Twenty-two cases of dry-abdomen were detected by transthoracic echocardiography in 2 72 cases, with a coincidence rate of 90.4%. (2) with age, reduce the chance of pulmonary hypertension, reduce the degree. Age less than 1 year old, the incidence of pulmonary hypertension was 70%, 7 to 14 years old was 28%. (3) With age, there is an increasing trend of aortic valve disease, but the difference was not significant, aortic valve disease occurred in 7 to 14 years old 38 7%. (4) With the increase of dry space, the incidence of pulmonary hypertension, the severity increased significantly, dry room more than 10mm, pulmonary hypertension rate of 523% or more. (5) There was no significant difference between the two groups in the incidence of aortic valve lesion with the enlargement of the dry room. (6) There were 267 cases (98.2%) with suture patch and 5 cases directly sutured. Among them, 267 cases (98.2%) were cured and 5 cases died (18%). Conclusion Due to its anatomical characteristics and hemodynamic characteristics, it has no natural tendency to close and may be complicated by serious complications. Therefore, this type of room should be treated with early surgery after it has been diagnosed.