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find Keyword "法洛四联症" 65 results
  • 杂交技术在法洛四联症治疗中的应用

    目的 总结法洛四联症(TOF)杂交手术的临床经验,探讨其手术技巧和效果。 方法 回顾性分析2006年7月至2012年7月广东省高州市人民医院重症TOF患者15例的临床资料,其中男10例、女5例,年龄4.2 (1.5~12.0) 岁,体重13.8 (10.0~42.0) kg。术前经超声心动图和螺旋CT检查确诊。外科术前介入治疗:所有患者行TOF根治术前均行侧枝血管栓塞术,其中2例采用AGA Plug血管塞封堵体肺侧枝血管,其余均采用COOK非可控弹簧圈栓塞体肺侧枝血管。侧枝血管栓塞术后立即行一期外科根治手术。 结果 15例患者中共发现体肺侧枝血管24支,封堵19支,未出现造影或封堵并发症,外科根治术后未出现灌注肺、低心排血量综合征等严重并发症。全组手术均效果满意,痊愈出院。住院时间8.5 (7~12) d。随访2年,无并发症,小儿患者发育正常。 结论 杂交手术治疗重症TOF安全、有效、可行,值得临床推广。

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • Surgical Treatment of Tetralogy of Fallot with Anomalous Coronary Artery

    Abstract: Objective To summarize our surgical experience of tetralogy of Fallot(TOF) with anomalous coronary artery(ACA), explore diagnostic method of ACA, and evaluate surgical strategy choices and clinical outcomes of right ventricular outflow tract(RVOT) reconstruction. Methods From January 2004 to January 2010, 29 patients with TOF and ACA underwent total correction in Wuhan Asia Heart Hospital. There were 18 male patients and 11 female patients with their median age of 7 years (5 months to 33 years)and median body weight of 18 (5 to 51) kg at operation. Their preoperative arterial oxygen saturation was 65%-91%. One patient underwent RVOT enlargement and repair of ventricular septal defect via right atrial approach. Three patients underwent RVOT enlargement, repair of ventricular septal defect and main pulmonary artery enlargement using autologous pericardium patch via right atrial approach. Three patients received pulmonary artery translocation (REV) technique. Five patients received double outlet technique. Eleven patients underwent RVOT enlargement via incisions above, below or beside coronary arteries (single patch or two patch technique). Six patients underwent RVOT reconstruction using trans-annular patch after coronary artery bypass grafting. Results  The median cardiopulmonary bypass time was 78 (65-102) min, median aortic crossclamp time was 50(40-82) min, and median operation time was 150 (126-178) min. There was no early death or severe coronary artery injury. Two  patients underwent reexploration because of postoperative bleeding. Two patients had low cardiac output and were both cured with inotropic support. The median follow-up period was 51 (21-83)months and there was no late death during  follow-up. All the patients were in New York Heart Association (NYHA) classⅠduring follow-up, their left ventricular ejection fraction was normal, there was no sign of myocardial ischemia in electrocardiogram, and their arterial oxygen saturation was 96%-99%.Mean early RVOT gradient (△P) was 19 (8-38) mm Hg, and the RVOT gradient (△P) did not increase during follow-up. Conclusion Preoperative diagnosis of ACA in TOF patients can be made by 64-slice multislice compute tomography (64-MSCT). Proper surgical strategy for RVOT reconstruction should be chosen according to the distribution of coronary arteries to achieve satisfactory surgical outcomes.

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • 婴幼儿法洛四联症根治术62例

    目的 总结婴幼儿法洛四联症(TOF)根治术治疗经验,提高婴幼儿TOF根治术的成功率。 方法 2007年5月至2011年12月盛京医院共施行62例年龄≤3岁婴幼儿TOF根治术,其中男35例,女27例;年龄(16.18±10.45) 月,≤1岁30例。所有患儿术前均常规行心脏超声心动图、心脏大血管CT及三维重建、胸部X线片、心电图等检查明确诊断为TOF,全部在体外循环下进行根治手术。 结果 手术早期死亡率6.4% (4/62),4例均死于并发低心排血量综合征。主动脉阻断时间(68.35±21.43) min,体外循环时间(96.90±30.36) min,术后住院时间(12.00±3.68) d。 结论 低龄低体重的婴幼儿行TOF根治术临床效果良好,手术技巧及矫治畸形的方法是手术成功的关键。良好的体外循环转流及心肌保护,加强术后监护对提高婴幼儿TOF根治术的临床效果有重要意义。

    Release date:2016-08-30 05:46 Export PDF Favorites Scan
  • 婴幼儿法洛四联症的手术治疗效果分析

    目的 探讨婴幼儿法洛四联症根治术的手术治疗效果。 方法 回顾性分析2008年9月至2009年6月59例在湖南省儿童医院行婴幼儿法洛四联症根治术59例患者的临床资料。其中男37例,女22例;年龄0.5~3.0 (1.9±0.4) 岁。分析其早期和中期效果。 结果 治愈率为94.9% (56/59),死亡率为5.1% (3/59),术后并发症发生率为16.9% (10/59)。体外循环时间为(105.2±9.5) min,主动脉阻断时间为(72.8±5.1) min,术后呼吸机辅助呼吸时间为(42.6±8.2) h,住院时间为(17.9±1.7) d。随访2年后,所有生存患儿的远期疗效均良好,紫绀消失,活动量明显增加。 结论 婴幼儿法洛四联症根治术近远期疗效良好,值得在临床上推广与应用。

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • 分两期手术治疗重症法洛四联症

    目的 总结分期手术治疗重症法洛四联症的经验,减少其并发症发生率,降低死亡率。 方法 2008年1月至2011年5月河南省胸科医院共收治法洛四联症351例,其中分期手术治疗重症法洛四联症患者10例,男6例,女4例;体-肺分流术前年龄5个月~12岁,平均3岁10个月;平均体重14.05 (8~27) kg;体表面积平均0.59 (0.38~1.0) m2;血氧饱和度平均69.68% (56%~83%)。10例患者均采取分两期的手术方式,第一期手术方式为体-肺动脉分流术,第二期为法洛四联症根治术。 结果 10例患者两次手术间隔时间平均18.2个月。体-肺动脉分流手术前与根治术前的血氧饱和度分别是69.68%和80.90% (P<0.05)。两者的Nakata指数分别为134.37 mm2/m2和244.92 mm2/m2 (P<0.01)。两者的左心室舒张期末容积指数(LVEDVI)分别为23.16 ml/m2和40.45 ml/m2 (P<0.05)。门诊随访10例患者,随访1~36个月,术后均恢复良好,心脏超声心动图检查提示室间隔无残余分流、右心室流出道血流通畅。 结论 重症法洛四联症患者采取分两期手术治疗效果良好。

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • 联合右心房-肺动脉切口手术一期根治婴幼儿法洛四联症

    目的 探讨联合右心房-肺动脉切口径路手术一期根治婴幼儿法洛四联症(TOF) 的疗效,总结其临床经验。 方法 回顾性分析 2006年1月至2012年1月解放军第91中心医院采用联合右心房-肺动脉切口径路行一期根治术治疗69例婴幼儿TOF的临床经验,其中男47例,女22例;年龄5个月至2岁7个月;体重5~16 kg。心脏超声心动图提示:左心室舒张期末容积指数(LVEDVI) 24.5~36.9 ml/m2,Nakata指数>120 mm2/m2,McGoon比值1.15~2.20。 结果 围术期死亡2例,死亡率2.9%,其中术后死于肺部感染1例,渗漏综合征1例。术后患者血流动力学平稳,不需使用大剂量的血管活性药物。呼吸机辅助呼吸时间(11.7±9.3) h,住ICU时间(38.2±20.7) h。生存的67例患者均顺利出院,动脉血氧饱和度由术前平均85%上升至99%,临床症状改善,活动耐量增加,心功能(NYHA分级)恢复至Ⅰ~Ⅱ级。随访67例,随访率100%,随访时间11~70个月。随访期间无死亡,1例于术后3个月因大量心包积液行心包穿刺引流,1例于术后8个月因肺动脉瓣狭窄再次行手术矫治,其余患者恢复良好,心功能(NYHA分级)Ⅰ~Ⅱ级。 结论 联合右心房-肺动脉切口径路手术一期根治婴幼儿TOF安全、可行,较常规手术缩短了体外循环时间,减少了右心室创伤,避免患者远期右心室功能衰竭、室性心律失常导致的猝死,有利于患者远期生存,效果满意。

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • 64层螺旋CT对法洛四联症和右心室双出口合并体肺侧枝血管的诊断

    目的探讨 64层螺旋 CT在法洛四联症和右心室双出口合并体肺侧枝血管诊断中的临床价值。方法回顾分析 2007年 11月至 2009年 12月哈尔滨医科大学附属第一医院收治 38例先天性心脏病患者的临床资料,其中男 14例,女 24例;年龄 1~ 44岁。心脏超声心动图提示:法洛四联症 33例,右心室双出口 5例。收集患者心脏、大血管 64层螺旋 CT资料,分析体肺侧枝血管的支数及其分布规律。结果 38例患者中有 34例 (89.5%)有体肺侧枝血管 81支,平均 2.38支 /例。体肺侧枝血管主要起源于主动脉峡部 18支(22.2%),降主动脉肺门区 37支(45.7%),和头臂血管 19支(23.5%)。结论 64层螺旋 CT可清楚显示法洛四联症和右心室双出口患者体肺侧枝血管情况。

    Release date:2016-08-30 05:49 Export PDF Favorites Scan
  • Treatment Progress of Chronic Postoperative Pulmonary Regurgitation after Surgical Repair of Tetralogy of Fallot

    Abstract: With the evolvement of surgical, anesthetic, perfusion, and perioperative management techniques, the mortality of routine corrective operation of tetralogy of Fallot(TOF) has been less than 2%-3%, while more and more attention has been paid to patient long-term prognosis. Chronic postoperative pulmonary regurgitation (PR) is one of the important prognostic factors which are puzzling cardiac surgeons. Subsequent right ventricle dilation, right ventricular dysfunction and fatal arrhythmias as chronic PR complications have important impact on the postoperative quality of life and long-term survival. Current treatment choice for PR includes pulmonary valve replacement(PVR), intervention, and hybrid procedures. PVR is the main surgical method for chronic PR which can significantly improve patient cardiac function and clinical symptoms,and prolong long-term survival. Intervention does not require thoracotomy once again, and can thus reduce surgical trauma and risks. Intervention is also helpful to improve right ventricular pressure conditions and PR degree. This article focuses on the pathophysiological changes of chronic PR after surgical repair of TOF, surgical indications for PVR, clinical treatment progress and early prevention of PR.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • Right Ventricular Outflow Tract Reconstruction with Valved Bovine Jugular Vein Patch in Patients with Complex Congenital Heart Disease

    Objective To evaluate early results of valved bovine jugular vein patch for reconstruction of the right ventricular outflow tract (RVOT).?Methods From May 2009 to March 2010, a total of 60 patients with complex congenital heart diseases underwent reconstruction of RVOT with valved bovine jugular vein patch in Wuhan Asia Heart Hospital. There were 42 males and 18 females with their mean age of 6.2±8.9 years (ranging from 5 months to 33 years) and mean body weight of 27.5±24.0 kg, and 34 patients were less than 1 year. Preoperative clinical diagnosis included tetralogy of Fallot (n=38) and double outlet of right ventricle with pulmonary stenosis (n=22). All the patients underwent one-stage surgical repair. Before operation, 4 patients underwent catheter intervention for their major aortopulmonary collaterals. The diameters of pulmonary arterial ring of all the patients were 2 standard deviation less than normal range, and trans-annular patch was chosen for RVOT reconstruction. All the patients were postoperatively followed up for 18 to 26 months (mean 21.2±4.6 months).?Results There was no in-hospital death. And no second surgical intervention was needed for conspicuous RVOT stenosis or pulmonary regurgitation. Three patients needed reintubation for lung edema after extubation as a result of major aortopulmonary collaterals. Four patients underwent reexploration for postoperative bleeding. And all the other patients were discharged uneventfully. Mean cardiopulmonary bypass time was 84.0±22.0 min, and mean aortic cross-clamping time was 42.0±12.0 min. Mean RVOT gradient right after surgery was 18.0±4.5 mm Hg, which was not statistically different from mean RVOT gradient of 19.2±5.4 mm Hg measured by transthoracic echocardiography at their last postoperative follow-up(P>0.05). The degree of pulmonary regurgitation right after surgery was trivial in 32 patients(1+), mild in 28 patients(2+), which were not statistically different from the degree of pulmonary regurgitation at their last postoperative follow-up: trivial in 28 patients (1+), mild in 27 patients(2+), and moderate in 5 patients(3+). Calcification was not observed on the valved bovine jugular vein patch and valve cusp, and the valve cusp motioned well. No thrombosis or endocarditis was observed on the valved bovine jugular vein.?Conclusions For patients with tetralogy of Fallot or double outlet of right ventricle (DORV) and pulmonary stenosis, valved bovine jugular vein patch is a good choice for trans-annular reconstruction of RVOT. There is no severe postoperative complication related to bovine jugular vein, the RVOT pressure gradient does not increase significantly, and anti-regurgitation result is satisfactory in short-term follow-up. Further follow-up is required to evaluate its long-term outcome.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • Immediate and Intermediate Outcomes of Correction on Patients with Tetralogy of Fallot and Absent Pulmonary Valve

    Objective To summarize the immediate and intermediate outcomes of surgical correction on patients with tetralogy of Fallot and absent pulmonary valve (TOF/PVAB). Methods From January 1996 to August 2009, 14 patients,including 5 males and 9 females, aged 3.4±3.4 years (0.2-11.0 years) with an average weight of 12.0±6.3 kg (4-26 kg), underwent complete surgical correction in Beijing Fu Wai Cardiovascular Hospital. The right ventricular outflow tract was reconstructed with valved conduit in 4 patients, and monocusp with transannular patch was used in 10 patients. Six patients underwent pulmonary artery wall reduction, and 2 patients underwent both pulmonary artery plication and wall reduction. Results There were 2 (14.3%) perioperative deaths. Both were low bodyweight infants. One died of low cardiac output and respiratory failure, and the other died of central nervous system complications. Ten patients were followed up for an average time of 8.3±4.3 years (0.6-13.0 years). All patients followed up survived. The echocardiogram found pulmonary valvular dysfunction in 4 patients. The patients’ cardiac function were classified as New York Heart Association(NYHA) Ⅰ to Ⅱ. There was no late death or reoperation. Conclusion The immediate and intermediate outcomes of surgical correction of TOF/PVAB are good, but the function of pulmonary valves and conduit should be followed-up closely.

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