Search

Turner综合征合并复杂先天性心脏畸形一例

经右心房切口行右心室流出道疏通术

目的　总结右心室流出道梗阻经右心房切口、三尖瓣口行右心室流出道疏通术的经验。　方法　自2007年6月至2010年12月，安徽医科大学第一附属医院对21例右室双腔心、单纯右心室流出道狭窄及法洛四联症患者［（14例右室双腔心、4例单纯右心室流出道狭窄和3例法洛四联症，流出道压差为（52.56±17.31） mm Hg］，经右心房切口、三尖瓣口行右心室流出道疏通术，切除异常纤维环和增生肥厚肌束，疏通右心室流出道，对并发肺动脉瓣或瓣下狭窄的患者，再经肺动脉根部切口协助显露，同时矫正其他并发畸形。　结果　所有患者手术顺利，术后心功能均恢复满意，术后超声心动图复查提示：右心室流出道疏通效果满意，压差＜20 mm Hg，7例术后有轻度收缩期杂音。术后随访至6个月，随访期间所有患者体力活动完全恢复；复查心脏彩色超声心动图提示:无明显右心室流出道室壁肥厚增生和再梗阻，右心室流出道压差进一步缩小或消失。　结论　经右心房切口行右心室流出道疏通术适用于右室双腔心、单纯右心室流出道狭窄及部分法洛四联症患者，可避免直接切开右室壁引起的心肌、冠状动脉损伤，减轻了术后瘢痕纤维增生，有利于术后心功能恢复。

Minimally invasive cardiac surgery for cardiac atrioventricular valve reoperation

ObjectiveTo summarize the clinical experiences of minimally invasive cardiac surgery (MICS) for cardiac atrioventricular valve reoperation.MethodsPerioperative data of 32 patients who underwent MICS for cardiac atrioventricular valve reoperation from 2009 to 2019 in the First Affiliated Hospital of Anhui Medical University were retrospectively reviewed, including 13 males and 19 females with a mean age of 51.0±12.6 years. All patients were given combined intravenous and inhalation anesthesia, and a double-lumen tube for mechanical ventilation. Cardiopulmonary bypass was established in all patients by femoral artery and venous cannulation or combined with percutaneous superior vena cava cannulation, without aortic cross-clamping. The MICS approaches included right anterolateral small incision surgery, thoracoscopic assisted small incision surgery and total thoracoscopic surgery. The clinical data of the 32 patients were compared with the perioperative indicators of 24 patients undergoing reoperation with conventional median thoracotomy during the same period.ResultsAmong them, 21 patients underwent isolated tricuspid valve replacement, 4 isolated tricuspid valvuloplasty, 1 combined tricuspid valve replacement and atrial septal defect repair and 6 combined mitral valve replacement and tricuspid valvuloplasty. Twenty-seven patients completed the operation in a beating heart, and 5 under the condition of ventricular fibrillation. Operation time (3.23±1.56 h vs. 5.46±2.13 h, P<0.001), postoperative mechanical ventilation time (9.19±5.40 h vs. 43.23±21.74 h, P<0.001), ICU stay (35.03±18.26 h vs. 79.15±22.43 h, P<0.001) and hospital stay of patients with minimally invasive surgery (9.35±6.43 d vs. 15.85±7.56 d, P=0.001) were shorter than those with median thoracotomy. And the extracorporeal circulation time was not significantly prolonged. There were 4 perioperative complications in patients with minimally invasive surgery, and 1 died in hospital after operation.ConclusionMICS for cardiac atrioventricular valve reoperation can avoid the risk of median sternotomy and separation of cardiac scar adhesion. Especially, total thoracoscopic surgery has more advantages when compared with other operations, including less trauma, less myocardial ischemia reperfusion injury, more rapid recovery and fewer postoperative complications. Total thoracoscopic surgery may be the development direction of MICS for cardiac atrioventricular valve reoperation. However we should take effective and feasible measures to solve the problems caused by cardiopulmonary bypass.