Hartyánszky István, Lozsádi Károly, Király László, Prodán Zsolt, Mihályi Sándor, Bodor Gábor, Tamás Csaba
Gottsegen György Országos Kardiológiai Intézet, Gyermekszív Központ, Budapest.
Orv Hetil. 2005 Jan 9;146(2):69-73.
Nowadays, due to the development of cardiac surgery, pediatric cardiology and anesthesia, almost every congenital heart disease can be corrected totally or partially. The increasing number of surgical corrections will lead to better life quality. The surgical mortality has decreased significantly, even in the most complex cases. Only few cases can not be treated surgically. The aim of this study was to examine these positive changes, what they mean in the treatment of premature babies with congenital heart disease. These patients are endangered because of their age as well, they require special treatment and the surgical treatment has always meant high risk, urgent interventions.
between 01. 01. 1975. and 31. 12. 2003. 447 premature babies were operated on. The patients were divided into 3 subgroups by their weight: I: 470-1500 gr. - 19 patients, II: 1500-2000 gr. - 93 pts., IIl: > 2000 gr. - 335 pts. There were 69 corrective surgical procedures performed mainly after 1998.
Overall early mortality: 81 patients (18.1%). Detailed mortality: group I.: 0%, group 11: 23 (24.7%), group III.: 58 (17.3%). The early mortality reduced from 21.6% to 6.3% (closed procedure), and 27.7% to 10.8% (ECC operation). The successful operations in the smallest weight groups were as follows: On ECC: Total Anomalous Pulmonary Venous Return (1600 g), Transposition of the Great Arteries--Arterial Switch (1800 g), Ventricular Septal Defect (1800 g), Aortopulmonary fenestration (2000 g), Hypoplastic Left Heart Syndrome-Norwood procedure (2200), AV septal defect (2300 g), Interrupted aortic arch + Ventricular Septal Defect (2300 g), Truncus arteriosus (2500 g). Without ECC: Coarctation of the aorta (930 g), Patent Ductus Arteriosus (470 g).
Nowadays the possibilities and the chances of the corrective procedures of congenital heart diseases in those patients with bodyweight of over 2000 g and in those that are mature babies are the same. In those patients with bodyweight 1500-2000 g procedures without ECC had good results, on-pump procedures had higher mortality rate, but the long-term results were acceptable. At the moment only procedures without ECC are performed on babies with weight under 1500 g--but with higher risk. Our effort is to perform ECC operations in patients with bodyweight less than 1500 g.
如今，由于心脏外科手术、小儿心脏病学和麻醉学的发展，几乎每种先天性心脏病都能得到完全或部分矫正。手术矫正数量的增加将带来更好的生活质量。手术死亡率已显著下降，即使在最复杂的病例中也是如此。只有极少数病例无法进行手术治疗。本研究的目的是探讨这些积极变化，以及它们在先天性心脏病早产儿治疗中的意义。这些患者因其年龄也面临风险，他们需要特殊治疗，而手术治疗一直意味着高风险、紧急干预。
在1975年1月1日至2003年12月31日期间，对447名早产儿进行了手术。患者按体重分为3个亚组：I组：470 - 1500克，共19例；II组：1500 - 2000克，共93例；III组：> 2000克，共335例。主要在1998年之后进行了69例矫正手术。
总体早期死亡率：81例患者（18.1%）。详细死亡率：I组：0%，II组：23例（24.7%），III组：58例（17.3%）。早期死亡率从21.6%降至6.3%（闭合手术），从27.7%降至10.8%（体外循环手术）。最小体重组成功进行的手术如下：体外循环手术：完全性肺静脉异位引流（1600克）、大动脉转位 - 动脉调转术（1800克）、室间隔缺损（1800克）、主肺动脉窗（2000克）、左心发育不良综合征 - 诺伍德手术（2200克）、房室间隔缺损（2300克）、主动脉弓中断 + 室间隔缺损（2300克）、动脉干（2500克）。非体外循环手术：主动脉缩窄（930克）、动脉导管未闭（470克）。
如今，体重超过2000克的患者以及足月婴儿进行先天性心脏病矫正手术的可能性和机会是相同的。体重在1500 - 2000克的患者，非体外循环手术效果良好，体外循环手术死亡率较高，但长期结果可以接受。目前，体重低于1500克的婴儿仅进行非体外循环手术，但风险较高。我们的努力方向是对体重低于1500克的患者进行体外循环手术。
