McCabe J C, Engle M A, Gay W A, Ebert P A
Am J Cardiol. 1977 Jan;39(1):72-7. doi: 10.1016/s0002-9149(77)80014-3.
A recent surgical experience with the spectrum of atrioventricular (A-V) canal is reviewed. Twenty-five patients underwent surgery for the partial and complete from of this defect in the 4 years from 1971 through 1974. Sixteen had a partial defect, two a transitional defect and seven complete A-V canal. The characteristic murmurs accompanied by cardiac enlargement, pulmonay overcirculation and left axis deviation in the electrocardiogram were sufficient for diagnosis in most cases. Cardiac catherization was performed in all patients preoperatively and in 11 postoperatively. The operative approach, including a double patch modification of the usual repair for complete canal, is considered. Definitive repair, rather than pulmonary arterial banding, is advocated regardless of the patient's age. The operative mortality rate is low in patients with the ostium primum type of defect but is related to associated intracardiac anomalies in those with the complete form of the defect. Residual mitral insufficiency is a common finding after surgical repair of both partial (75 percent) and complete (100 percent) A-V canal. Although no patient in the series died of florid mitral regurgitation, the long-range effects of this complication may lead to mitral valve replacement.
本文回顾了近期一组房室管畸形的外科治疗经验。1971年至1974年的4年间，25例患者因部分型和完全型该缺损接受了手术治疗。其中16例为部分型缺损，2例为过渡型缺损，7例为完全性房室管畸形。大多数病例中，特征性杂音伴心脏扩大、肺循环血流量增多及心电图电轴左偏足以确诊。所有患者术前均行心导管检查，11例术后也进行了检查。文中讨论了手术入路，包括对完全性房室管畸形常规修补术的双补片改良。无论患者年龄如何，均主张进行确定性修补而非肺动脉环扎术。原发孔型缺损患者手术死亡率较低，但完全型缺损患者的手术死亡率与合并的心内畸形有关。部分型（75%）和完全型（100%）房室管畸形手术修复后，残留二尖瓣关闭不全均很常见。尽管该组患者中无1例死于明显的二尖瓣反流，但该并发症的远期影响可能导致二尖瓣置换术。
