Murayama Hiroomi, Watanabe T, Yano T, Kida N, Ohara K, Kobayashi A, Yasuda K, Nomura T
Department of Thoracic and Cardiovascular Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan.
Kyobu Geka. 2006 Feb;59(2):114-8.
We report a surgical technique for off-pump atrial septectomy using a Rongeur forceps in the case of a newborn infant weighing less than 2,000 grams. The 6-day-old patient suffered from hypoplastic left heart syndrome with a restrictive interatrial communication. A purse-string suture was placed on the right atrium. A hand-made dull-tipped cannula was inserted into the right atrium through the suture to probe the interatrial communication. Monitoring the pressure at the tip of cannula, we could clearly determine when the cannula tip entered the left atrium. Then, a Rongeur forceps was inserted instead of the cannula, and used to bite into the interatrial septum. It was removed slowly together with the resected atrial specimen. In this manner, an atrial septectomy can be performed without cardiopulmonary bypass; this is far safer and easier than other procedures, such as the Blalock-Hanlon technique. This method can be performed in a small neonate as well as an older infant in whom balloon atrial septostomy is difficult.
我们报告了一种在体重小于2000克的新生儿中使用咬骨钳进行非体外循环房间隔切除术的手术技术。这名6天大的患者患有左心发育不全综合征，伴有限制性房间隔交通。在右心房放置了荷包缝合线。通过缝合线将手工制作的钝头套管插入右心房，以探测房间隔交通。监测套管尖端的压力，我们可以清楚地确定套管尖端何时进入左心房。然后，将咬骨钳代替套管插入，并用于咬入房间隔。它与切除的心房标本一起缓慢取出。通过这种方式，可以在不进行体外循环的情况下进行房间隔切除术；这比其他手术，如布莱洛克 - 汉隆技术，要安全得多且更容易。这种方法可以在小新生儿以及难以进行球囊房间隔造口术的较大婴儿中实施。
