[1]张海波,徐志伟,刘锦纷,等.心内直视杂交封堵肌部多发室间隔缺损[J].中国微创外科杂志,2011,11(5):421-423.
　Zhang Haibo,Xu Zhiwei,Liu Jinfen,et al.Hybrid Approaches under Direct Vision for the Management of Muscular Ventricular Septal Defects[J].Chinese Journal of Minimally Invasive Surgery,2011,11(5):421-423.
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心内直视杂交封堵肌部多发室间隔缺损()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
11
期数:
2011年5期
页码:
421-423
栏目:
出版日期:
2011-05-20

文章信息/Info

Title:
Hybrid Approaches under Direct Vision for the Management of Muscular Ventricular Septal Defects
作者:
张海波; 徐志伟; 刘锦纷; 苏肇伉; 丁文祥
上海交通大学附属上海儿童医学中心心胸外科，上海200127
Author(s):
Zhang Haibo;  Xu Zhiwei;  Liu Jinfen;  et al.
Shanghai Children’s Medical Center, Shanghai Jiaotong University Medical School, Shanghai 200127, China
关键词:
杂交封堵;  心内直视;  肌部多发室间隔缺损
Keywords:
Hybrid approaches; Direct vision; Muscular ventricular septal defects
分类号:
R654.2
文献标志码:
A
摘要:
目的总结心内直视杂交封堵肌部多发室间隔缺损（室缺）的经验。方法2006年4月～2009年12月，行21例心内直视杂交封堵肌部多发室间隔缺损术。男15例，女6例。3例年龄分别为4、7和15岁；余18例平均手术年龄8个月（2～11个月），平均体重5.8 kg（4～8 kg）。19例伴心内外畸形，包括膜周室缺、肌部流入道室缺、肺动脉瓣下室缺、房间隔缺损、动脉导管未闭、二尖瓣反流、主动脉缩窄、三尖瓣反流、冠状动脉畸形和先天性房室传导阻滞等。心内直视杂交封堵解剖纠治方法：主动脉及上下腔静脉插管，浅低温体外循环（肛温32～34 ℃），阻断主动脉，右心房切口，经由房间隔径路探及肌部室间隔缺损，经缺损右室面过导引钢丝及鞘管，导入封堵器行肌部室缺封堵器封堵。伴心内畸形者，行同期纠治。结果手术无死亡，食道彩超无影响心功能的明显残余分流。1例术后发生肺动脉高压危象，术后3天延迟关胸。术后随访6个月～3年，无死亡，2例术后心尖部小缺损开放，7例封堵器边缘残留少量左向右分流。全组左心室射血分数0.64±0.04，左心室缩短率35%±4%，心功能正常。结论心内直视杂交封堵肌部多发室间隔缺损，可避免传统手术纠治需心室切口、心室内肌束切开和残余分流率高、对心功能影响大的缺点；且可缩短体外循环时间，并同期纠治伴发畸形，手术简便、安全，尤其适用于婴幼儿，可获得较佳近中期疗效。
Abstract:
ObjectiveThe purpose of this study is to describe our experience in hybrid approaches for the management of muscular ventricular septal defects (mVSDs). MethodsFrom April 2006 to December 2009, we used hybrid approaches in 21 patients with mVSDs (15 male and 6 female). Eighteen of the patients aged 2 to 11 months (mean, 8 months) with a mean weight of 5.8 kg (4-8 kg), and the other three aged at 4, 7, and 15 years respectively. Nineteen of the patients were complicated with intra or extracardiac malformations including inlet or perimembranous ventricular septal defect, atrial septal defect, coarctation of aorta, patent ductus arteriosus, mitral valve regurgitation, tricuspid valve regurgitation, coronary artery anomaly and congenital heart block. After superior or inferior vena cava cannulation and establishment of extracorporeal circulation (anal temperature: 32-34 ℃), we blocked the aorta, and made an incision at the right atrium to explore the ventricular septal defect. Afterwards, we introduced a guide wiresheath to occlude the defect. Intracardiac malformations were corrected at the same time if any.ResultsNo patient died during the procedure. Esophageal ultrasonography found no marked residual shunt influencing heart function. One patient developed pulmonary hypertension crisis after the operation, and thus received a delayed chest closure in 3 days. The patients were followed up for 6 months to 3 years, during which none of them died. Two patients had the defect opened at the apex cordis after the operation. Seven cases had mild lefttoright residual shunt close to the occluder. The left ventricular ejection fraction was 0.64±0.04, and left ventricular fractional shortening was 35%±4%. None of the patients had abnormal cardiac function afterwards. ConclusionHybrid VSD device placement under direct vision for closure of mVSDs is feasible and effective to avoid ventriculotomy, division of intracardiac muscle bands,residual shunts,and impaired cardiac function,which are common complications of traditional surgery, and thus is an ideal option with good short and midterm outcomes for infant patients especially those with complicated lesions.

参考文献/References:

[1]Bacha EA,Hijazi ZM,Cao QL,et al.New therapeutic avenues with hybrid pediatric cardiac surgery.Heart Surg Forum,2004,7:33-40.
[2]Schmitz C,Esmailzadeh B,Herberg U,et al.Hybrid procedures can reduce the risk of congenital cardiovascular surgery.Eur J Cardiothorac Surg,2008,34:718-725.
[3]Kirklin JK,Castaneda AR,Keane JF,et al.Surgical management of multiple ventricular septal defects.J Thorac Cardiovasc Surg,1980,80:485-493.
[4]Wollenek G,Wyse R,Sullivan I,et al.Closure of muscular ventricular septal defects through a left ventriculotomy.Eur J Cardiothorac Surg,1996,10:595-598.
[5]Stellin G,Padalino M,Milanesi O,et al.Surgical closure of apical ventricular septal defects through a right ventricular apical infundibulotomy.Ann Thorac Surg,2000,69:597-601.
[6]Waight DJ,Bacha EA,Kahana M,et al.Catheter therapy of Swiss cheese ventricular septal defects using the Amplatzer muscular VSD occluder.Cathet Cardiovasc Intervent,2000,55:355-361.
[7]Amin Z,Gu X,Berry JM,et al.New device for closure of muscular ventricular septal defects in a canine model.Circulation,1999,100:320-328.
[8]Bacha EA,Marshall AC,McElhinney DB,et al.Expanding the hybrid concept in congenital heart surgery.Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann,2007,10:146-150.
[9]Bacha EAM,Hijazi ZM.Hybrid procedures in pediatric cardiac surgery.Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann,2005,8:78-85.
[10]Soukiasian HJ,Fontana GP.Surgeons should provide minimally invasive approaches for the treatment of congenital heart disease.Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann,2005,8:185-192.
[11]Diab KA,Hijazi ZA,Cao QL,et al.A truly hybrid approach to perventricular closure of multiple muscular ventricular septal defects.Thorac Cardiovasc Surg,2005,130:892.
[12]Alsoufi B,Karamlou T,Osaki M,et al.Surgical repair of multiple ventricular septal defects:the role of reendocardiatilization strategy.J Thorac Cardiovasc Surg,2006,132:1072-1080.

备注/Memo

备注/Memo:
基金项目：浦东新区科技发展基金创新资金，项目编号PKJ2007-Y01
更新日期/Last Update: 2013-04-18