Wu Qing-yu, Guo Hong-wei, Shen Xiang-dong, Li Shou-jun, Yan Jun, Guo Yan
Department of Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Yi Xue Za Zhi. 2004 Mar 17;84(6):486-8.
To summarize the experience in total repair of atrioventricular septal defect with tetralogy of Fallot or Fallot's type double outlet right ventricle.
Ten patients with atrioventricular septal defect associated with tetralogy of Fallot or Fallot's type double outlet right ventricle underwent repair between June 2000 and September 2002. Atrioventricular septal defect was repaired with a 2-patch technique. The ventricular patch material was dacron artificial vascular patch, autologous pericardium was used to close the ostium of atrial septal defect after repair of the atrioventricular valve. Closure of ventricular septal defect (VSD) necessitated a combined right atrial and right ventricular approach. Each patient underwent an extensive infundibulectomy performed through the right ventriculotomy. If the pulmonary valve was more than 1 mm or 2 mm in diameter, smaller than the normal size, a transannular pericardial patch was used. If abnormal coronary arteries existed in the surface of right ventricular outflow, a homograft was used to connect the right ventricle with pulmonary artery.
There was one death (10%) six months after repair. Two patients were not able to be extubated from ventilator because of residual VSD. After repairing the residual VSD, one patient was extubated from ventilator. The other still wasn't able to be extubated from ventilator due to right diaphragm paralysis. After folding right diaphragm, the patient got stable recovery.
Atrioventricular septal defect with tetralogy of Fallot or Fallot's type double outlet right ventricle can be corrected with low mortality. Residual VSD can severely affect recovery. Long-term results need to be followed up.
总结法洛四联症或法洛型右心室双出口合并房室间隔缺损的完全修复经验。
2000年6月至2002年9月期间，对10例法洛四联症或法洛型右心室双出口合并房室间隔缺损的患者进行了修复手术。采用双补片技术修复房室间隔缺损。心室补片材料为涤纶人工血管补片，在修复房室瓣后，使用自体心包关闭房间隔缺损口。室间隔缺损（VSD）的闭合需要联合右心房和右心室入路。每位患者均通过右心室切开术进行广泛的漏斗部切除术。如果肺动脉瓣直径超过1毫米或2毫米，小于正常大小，则使用经环心包补片。如果右心室流出道表面存在异常冠状动脉，则使用同种异体移植物连接右心室和肺动脉。
术后6个月有1例死亡（10%）。2例患者因残余VSD无法脱机。在修复残余VSD后，1例患者脱机。另1例患者由于右膈肌麻痹仍无法脱机。折叠右膈肌后，患者恢复稳定。
法洛四联症或法洛型右心室双出口合并房室间隔缺损可以通过低死亡率进行矫正。残余VSD会严重影响恢复。长期结果需要随访。
