Mohanty S R, Airan B, Bhan A, Sharma R, Kumar A S, Kothari S S, Saxena A, Venugopal P
Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi.
Indian Heart J. 1999 Mar-Apr;51(2):186-92.
Cyanotic congenital heart diseases constitute about 10 percent of total congenital heart disease cases in adults in the developing world. Prolonged cyanosis and old age adversely affect the outcome of surgery, thus posing a challenge to the cardiac surgeons. This study was conducted to assess the feasibility, safety and outcome of surgery in this group of patients. From January 1991 to December 1997, a total of 303 patients, aged 14 to 54 years (mean 19.8 +/- 1.5 years) with diagnosis of various cyanotic congenital heart diseases were operated at our institute. There were 210 males (69.3%). Two hundred and forty-seven patients (81.5%) had tetralogy of Fallot's physiology, 51 patients (16.8%) had single ventricle physiology and five (1.6%) had other lesions. Sixty-six patients (21.7%) had pre-operative complications such as haemoptysis, epistaxis, cerebrovascular accidents, brain abscess and infective endocarditis. Sixty patients (19.8%) had previous palliative shunts and 26 patients (8.5%) had coil embolisation of major aortopulmonary collaterals prior to surgery; 229 patients (75.5%) underwent biventricular repair, 52 (17.1%) had univentricular repair, 22 (7.7%) had palliative shunts and one patient had open ligation of a major aortopulmonary collateral in addition. In-hospital mortality was 3.3 percent. Follow-up period ranged from five months to seven years (mean 4.2 +/- 1.8 years). There were two late deaths. Of the 291 survivors, 11 were lost to follow-up. Two hundred and fifty-eight patients (92.1%) are in New York Heart Association class I. Significant residual defects warranting reoperation were present in four patients (1.3%). It is concluded that congenital heart surgery in older cyanotic patients can be performed safely with satisfactory results.
在发展中国家，青紫型先天性心脏病约占成人心血管先天性疾病病例总数的10%。长期的紫绀和高龄对手术结果产生不利影响，因此给心脏外科医生带来了挑战。本研究旨在评估该组患者手术的可行性、安全性和结果。1991年1月至1997年12月，共有303例年龄在14至54岁（平均19.8±1.5岁）、诊断为各种青紫型先天性心脏病的患者在我院接受手术。其中男性210例（69.3%）。247例（81.5%）患者具有法洛四联症生理特征，51例（16.8%）患者具有单心室生理特征，5例（1.6%）患者具有其他病变。66例（21.7%）患者术前有咯血、鼻出血、脑血管意外、脑脓肿和感染性心内膜炎等并发症。60例（19.8%）患者既往有姑息性分流术，26例（8.5%）患者在手术前行主要主肺动脉侧支血管的弹簧圈栓塞；229例（75.5%）患者接受双心室修复，52例（17.1%）患者接受单心室修复，22例（7.7%）患者接受姑息性分流术，另有1例患者接受主要主肺动脉侧支血管的开放结扎术。住院死亡率为3.3%。随访时间为5个月至7年（平均4.2±1.8年）。有2例晚期死亡。在291例幸存者中，11例失访。258例（92.1%）患者纽约心脏协会心功能分级为I级。4例（1.3%）患者存在需要再次手术的明显残余缺损。结论是，老年青紫型患者的先天性心脏手术可以安全进行，结果令人满意。
