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find Keyword "室间隔缺损" 100 results
  • A Cross-Linkage Mattress Suture to Repair Large Ventricular Septal Defect with Moderate to Severe Pulmonary Hypertension

    ObjectiveTo investigate the effect and incidence of residual leakage after surgical repair of large ventricular septal defects with moderate to severe pulmonary hypertension using cross-linkage mattress suture, a suture method invented by us, as compared with interrupted mattress suture. MethodsWe retrospectively analyzed the clinical data of 41 patients of large ventricular septal defect with moderate to severe pulmonary hypertension underwent surgery using cross-linkage mattress suture in Beijing Anzhen Hospital from February 2011 through April 2013. The 41 patients were as a cross-linkage group (average age 18.7±12.3 years, the ratio of male to female 31:10). Another 41 patients, who were repaired using interrupted mattress suture, were retrospectively chosen by matching age, size and location of the defects, pulmonary artery pressure and vascular resistance with members from the cross-linkage group, and were assigned as a control group (average age 17.4±11.8 years, the ratio of male to female 31:10). ResultsThere was no operative mortality and no new perioperative atrioventricular conduction block. Postoperative echocardiography revealed the incidence of residual leakage was 31.7% (13/41) in the control group, 0% (0/41) in the cross-linkage group with a statistical difference (χ2=13.164, P=0.000). With a follow-up of 18.2±6.1 months, no late death and no new atrioventricular conduction block occurred. There was no statistical difference in New York Heart Association functional class or pulmonary artery pressure measured through echocardiography between the two groups. While there was a statistical difference in incidence of residual leakage between the the cross-linkage group and the control group (0% (0/41) versus 26.8% (11/41), χ2=10.499, P=0.001). ConclusionThere is a high incidence of residual leakage after the surgical repair of large ventricular septal defect complicated with moderate to severe pulmonary hypertension using interrupted mattress suture, while the use of cross-linkage mattress suture can effectively reduce the incidence of residual leakage.

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  • Minimally Invasive Transthoracic Closure of Ventricular Septal Defect through Left Parasternal Approach: A Report of 15 Cases

    目的总结左胸骨旁小切口微创封堵分流方向偏向流出道的室间隔缺损(VSD)的初步经验。 方法2014年2~8月广州医科大学附属第一医院对15例分流方向偏向流出道的VSD患者施行左胸骨旁小切口微创封堵手术,其中男7例,女8例;年龄10个月~19岁(4.5±4.6)岁;体重5.5~54.0(14.6±14.1)kg;其中干下型6例,嵴内型6例,膜周部型3例;缺损直径2.5~6.5(4.0±1.2)mm,距主动脉瓣环距离≤1 mm 9例,≤2 mm4例,>2 mm 2例;合并主动脉瓣右冠瓣轻度脱垂5例;采用左胸骨旁第2或第3肋间1.5~2.5 cm切口,在经食管超声心动图(TEE)监视下在右心室流出道表面选择适当的穿刺点,建立VSD输送轨道并置入封堵器,观察有无残余分流、主动脉瓣反流;术后3个月复查经胸超声心动图。 结果15例均成功封堵,无中转开胸,无残余分流和心律失常,新发主动脉瓣轻微反流2例,围手术期输血1例;手术时间30~120(58±28)min,术中出血量5~200(26±50)ml;术后住院时间3~13(4.3±2.6)d,无二次开胸止血、Ⅲ°房室传导阻滞、主动脉瓣反流加重、溶血、切口感染等并发症;术后3个月返院复查经胸超声心动图13例,无新发主动脉瓣反流和封堵器脱落;2例术中新发主动脉瓣反流加重,其中1例出现残余分流。 结论左胸骨旁小切口封堵分流方向偏向流出道VSD 手术安全、切口小、操作简单,近期效果尚满意;对合并主动脉瓣轻度脱垂VSD 需慎重施行外科微创封堵手术。

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  • 双腔右心室的外科治疗

    Release date:2016-08-30 05:45 Export PDF Favorites Scan
  • “一鞘两伞” Hybrid 技术封堵室间隔缺损残余漏及左心室右心房通道一例

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • Surgical Treatment of Muscular Ventricular Septal Defect in Infants with Multiple Ventricular Septal Defects

      Objective To investigate surgical strategy for the treatment of muscular ventricular septal defect (MVSD) in infants with multiple ventricular septal defects(VSD). Methods Clinical data of 46 infants with multiple VSD who underwent surgical repair in Shanghai Children’s Medical Center from January 2010 to April 2012 were retrospectively analyzed. There were 24 males and 22 females with their age of 8±6 months and body weight of 6.1±1.9 kg. All the patients received one-stage surgical repair,among whom MVSD of 10 patients was not found and repaired during the surgery. MVSD was repaired by surgical suture in 19 patients,hybrid repair under direct vision in 12 patients,and hybrid repair via the right ventricle in 5 patients. All the patients were regularly followed up after discharge by chest X-ray,ECG and color Doppler echocardiography to observe the closure of MVSD and the presence of residual shunt. Results All the 46 patients with multiple VSD survived their surgery without perioperative death. Three patients undergoing hybrid repair under direct vision received delayed sternal closure. One patient undergoing hybrid repair under direct vision had postoperative cardiac dysfunction. All the 46 patients were followed up for 1-17 months. Twenty-three patients had residual shunt of varying degrees during follow-up,and most of the MVSD of patients with residual shunt were <4 mm,who were receiving further follow-up and evaluation. Conclusion Appropriate surgical strategies can be applied according to specific surgical views during the operation for the treatment of MVSD in infants with multiple VSD,and satisfactory clinical outcomes can be achieved.

    Release date:2016-08-30 05:46 Export PDF Favorites Scan
  • 经胸微创室间隔缺损封堵术38例临床分析

    目的 探讨食管超声心动图( TEE)引导下应用国产封堵器经胸微创封堵室间隔缺损(VSD)的临床价值。方法 回顾性分析自2011年5月至2012年5月内蒙古医学院第一附属医院38例VSD患者的临床资料,,男20例,女18例;年龄2.6~13.0岁;体重10~35 kg。其中膜部VSD 30例,干下型VSD 6例,肌部VSD 2例。术前经胸超声心动图检查符合封堵条件者在全身麻醉下经口插入食管超声探头,手术开始前重新评估VSD是否符合封堵治疗,如符合,根据VSD最大直径选择合适的封堵伞。于手术开始后,监测整个封堵过程,引导封堵伞的位置,评价即刻封堵效果,确认是否有残余分流及并发症。 结果 38例患者均一次封堵成功,置入封堵器直径4~10 mm,TEE显示封堵器与VSD边缘吻合紧密无残余分流。术后4~7 d复查心脏彩色超声心动图提示封堵器位置正常、牢固,无残余分流,主动脉瓣无反流。随访31例,随访时间10~24个月,未出现新的瓣膜和主动脉瓣反流,无溶血和血栓形成,无封堵器位置移动现象,未发现左、右心室流出道狭窄,手术切口隐蔽,基本不影响美观。 结论经胸微创VSD封堵术安全、有效,无需体外循环、创伤小,无需X线辅助,住院时间短,使该手术成为更简便、可行、成功率更高的封堵方法,值得临床广泛推广应用。

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • 双心室矫治术治疗右心室双出口合并完全性房室间隔缺损

    目的总结右心室双出口( DORV)合并完全性房室间隔缺损( AVSD)的双心室解剖矫治经验。方法回顾性分析 1996年 1月至 2010年 12月阜外心血管病医院 14例 DORV-AVSD患者施行双心室解剖矫治术的临床资料,其中男 9例,女 5例;年龄 6个月~ 31岁。患者均行双心室解剖矫治术,经右心房和右心室切口,疏通右心室流出道,分隔并成形房室瓣,采用“逗号状”补片修补室间隔缺损,同时构建通畅的左心室流出道,自体心包闭合Ⅰ孔房间隔缺损,用心包或跨瓣环补片加宽右心室流出道。结果 1996年 1月至 2008年 12月收治的 10例患者中,住院死亡 5例,其中术中不能脱离体外循环 3例,不能脱离呼吸机 2例;住院时间 23~ 105 d,住 ICU时间 5~ 90 d,机械通气时间 1~ 52 d。 2009年 1月至 2010年 12月收治的 4例患者中,无住院死亡,术后未发生并发症;住院时间 21~ 41 d,住 ICU时间 4~ 21 d,机械通气时间 1~ 7 d。随访 9例,随访时间 6~ 26个月,随访期间无死亡,无流出道残余梗阻。结论 DORV-AVSD患者可一期行双心室矫治术,近年来手术效果明显提高。

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • Long-term Outcomes of Surgical Repair for Pulmonary Atresia with Ventricular Septal Defect and Major Aortopulmonary Collateral Arteries

    Objective To evaluate long-term outcomes of surgical repair for pulmonary atresia with ventricular septal defect (PA-VSD) and major aortopulmonary collateral arteries (MAPCAs).?Methods?We retrospectively analyzed the clinical data of 29 patients with PA-VSD and MAPCAs who underwent surgical repair in Shanghai Children’s Medical Center from February 2001 to February 2010. There were 13 patients in the one-stage operation group and 16 patients in the staged operation group. There were 8 males and 5 females in the one-stage operation group with their age ranging from 8 to 168 (26.0±17.0)months. There were 9 males and 7 females in the staged operation group with their age ranging from 4 to 149 (26.5±15.8)months. Eight patients underwent their second operation with the time interval between the two operations ranging from 14 to 40 (28.3±11.7) months. For MAPCAs, 9 patients underwent unifocalization, 16 patients underwent ligation or occlusion via cardiac catheterization, and the other 4 patients left them open or unrepaired. We compared postoperative mortality, complications, long-term outcomes, and quality of life between the two groups. Quality of life of the 29 PA-VSD patients was measured according to Pediatric Quality of Life Inventory version 4.0 and compared with 100 children from a kindergarten as a control group.?Results?Postoperative mortality of one-stage operation group was significantly higher than that of staged operation group at 15.4% (2/13) vs. 0.0% with χ2=4.12 and P=0.04. There was no statistical difference in the rate of postoperative complications between the two groups at 75.0% (9/12) vs. 56.2% (9/16) with χ2=0.51 and P=0.47. Patients were followed up for 3 to 88 months, and the follow-up mortality of one-stage operation group was not significantly higher than that of staged operation group at 27.3% (3/11) vs. 6.2% (1/16) with χ2= 2.28 and P=0.13. There was no statistical difference in overall quality of life score between one-stage operation group and staged operation group (66.7±8.6 vs 70.2±13.0, t?=?-0.71, P=0.48) . The overall quality of life score of PA-VSD patients was significantly lower than that of control group (68.7±11.2 vs. 77.8±15.7, t?= 3.14, P=0.01), mainly because the physical functioning score of PA-VSD patients was significantly lower than that of control group (57.7±11.7 vs. 83.0±19.6, t?=5.67, P=0.00), but there was no statistical difference in emotional well-being score, social functioning score, and school functioning score between PA-VSD patients and the control group.?Conclusion It is the key to analyze different pulmonary artery conformation, choose individualized surgical procedure and properly manage MAPCAs so as to reduce postoperative mortality and complications of surgical repair for patients with PA-VSD and MAPCAs.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 部分型房室间隔缺损二尖瓣处理策略

    目的 总结部分型房室间隔缺损(PAVSD)患者外科手术的近远期疗效,探讨二尖瓣处理方法。 方法 回顾性分析1990年1月至2008年12月于第二军医大学长海医院行外科治疗PAVSD患者118例的临床和随访资料,男 51例,女67例;年龄7个月~62岁(28.5±12.6岁)。均有原发孔型房间隔缺损和不同程度的二尖瓣前瓣裂隙,其中二尖瓣中重度反流78例,三尖瓣中重度反流56例。手术均在中度低温体外循环下进行。术后通过门诊和电话随访。 结果 术后早期死亡2例,病死率1.69%。发生其他严重并发症为再次气管内插管5例,左心辅助1例,Ⅲ°房室传导阻滞1例。术后随访103例,随访时间3个月~18年(91.2±25.6个月)。再次手术8例,距第一次手术时间为5 d~18年(10.5±5.6年)。再次手术死亡1例。随访生存的102例患者生活质量均有明显改善。二尖瓣无反流70例,微量和轻度反流17例,中度4例。行二尖瓣置换术患者瓣膜功能良好,无抗凝相关并发症。心房颤动19例,Ⅰ°房室传导阻滞21例,频发性房性早搏4例。 结论 二尖瓣修复是PAVSD矫治手术成功的关键,应综合应用二尖瓣成形修复的方法,尽量消除二尖瓣反流;术后二尖瓣再反流是再次手术的主要原因,对中重度二尖瓣反流患者应定期随访和及时手术。

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • The Application of Palliative Operation in Staged Surgical Management of Pulmonary Atresia with Ventricular Septal Defect

    Abstract: Objective To assess the effects of three different palliative procedures including modified BlalockTaussig (B-T) shunt, Waterston shunt, and reconstruction of right ventricularpulmonary artery (RV-PA) continuity for pulmonary atresia with ventricular septal defect (PAVSD). Methods We retrospectively analyzed the clinical data of 93 patients with PAVSD who had undergone palliative surgical procedures including modifie BT shunt, Waterston shunt, and RVPA econstruction in Fu Wai Hospital from September 1998 to September 2008. There were 53 males and 40 females, aged from 14.0 days to 14.4 years, with the body weight ranged from 3.6 to 33.0 kg (9.9±6.3 kg). According to International Congenital Heart Surgery Nomenclature and Database Project, these patients were categorized into 2 groups: 64 of type Ⅰ and 29 of type Ⅱ. The most common associated anomaly is rightsided aortic arch (except for ventricular septal defect). The application of the three kinds of palliative surgical procedures in staged management of PAVSD and the followup results were statistically analyzed. Results The corrective rate of the three palliative procedures were 28.12% (18/64) for modified BT shunt, 7.14%(1/14) for Waterston shunt, and 66.67% (10/15) for RV-PA reconstruction, respectively. RV-PA reconstruction had a significantly higher corrective 〖CM(1585mm〗rate than the other two surgical procedures (P=0.016). The percutaneous oxygen saturation (SpO2) increased by 4%59% and Nakata index by 31-104 mm2/m2. No tortuous pulmonary artery was found under echocardiogram or angiocardiography after palliative operation. The perioperative mortality of both surgical stages was 10 patients. Twostage radical surgery was successfully performed for 25 patients, among whom 20 were followed up till May 2009. During the followup, one died suddenly, 15 were classified as New York Heart Association (NYHA) Ⅰ, and 4 as NYHA Ⅱ. Conclusion The surgical management of PAVSD needs to be improved continuously. Compared with shunting procedures, the RVPA reconstruction is a better palliative operation method, and the modified B-T shunt is preferred in younger patients.

    Release date:2016-08-30 05:56 Export PDF Favorites Scan
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