Chen Lin, Hao Jia, Ma Rui-Yan, Chen Bai-Cheng, Cheng Wei, Qin Chuan, Wang Xue-Feng, Xiao Ying-Bin
Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, P.R. China.
Heart Surg Forum. 2013 Oct;16(5):E257-63. doi: 10.1532/HSF98.2013217.
Partial atrioventricular septal defect (P-AVSD) is a common congenital heart disease. Because of the presence of left and right atrioventricular valve deformities and the shift in the atrioventricular node and cardiac conduction bundle, the surgical repair of P-AVSD is difficult. This study was performed to compare the effects on the coronary sinus septum in the left versus the right atrium during surgical treatment for P-AVSD and report our experiences regarding the application of on-pump beating heart surgery under mild hypothermia for patients with P-AVSD.
The effects of on-pump beating heart surgery were analyzed retrospectively in 87 P-AVSD patients. Of the 87 total patients, 84 with anterior mitral leaflet cleft underwent valvuloplasty and 3 underwent mitral valve replacement. Seventy-seven patients underwent tricuspid valve annuloplasty, 2 underwent tricuspid valve replacement, and 1 underwent left superior vena cava ligation, and 3 patients with atrial fibrillation were treated with radiofrequency ablation. Patients with an ostium primum atrial septal defect underwent autologous pericardial modified Kirklin repair. Of these, 46 patients had their coronary sinus septum separated into the left atrium and 41 had their coronary sinus retained in the right atrium. Fingertip oxygen saturation was compared between patients in whom the coronary sinus was separated to the left atrium and those in whom the coronary sinus was retained in the right atrium.
There was 1 postoperative early death (1.15%) due to respiratory failure, and 1 patient had a III degree atrioventricular block (1.15%) and underwent implantation of a permanent pacemaker. The fingertip oxygen saturation levels of the left atrium group were 96.81 ± 3.17 preoperatively, 95.37 ± 4.62 at 7 days postoperatively, and 94.53 ± 4.95 at 3 months postoperatively. Those of the right atrium group were 98.53 ± 2.84 preoperatively, 97.19 ± 3.57 at 7 days postoperatively, and 96.89 ± 4.19 at 3 months postoperatively. During the follow-up period, which ranged from 3 months to 7 years, the cardiac function was adequately restored.
On-pump beating heart surgery under mild hypothermia is a safe and feasible method. The retention of the coronary sinus in the right atrium might maintain oxygen saturation.
部分房室间隔缺损（P - AVSD）是一种常见的先天性心脏病。由于存在左右房室瓣畸形以及房室结和心脏传导束移位，P - AVSD的手术修复难度较大。本研究旨在比较P - AVSD手术治疗期间左心房和右心房对冠状窦间隔的影响，并报告我们在轻度低温体外循环心脏跳动手术治疗P - AVSD患者方面的经验。
回顾性分析87例P - AVSD患者体外循环心脏跳动手术的效果。87例患者中，84例二尖瓣前叶裂缺患者行瓣膜成形术，3例行二尖瓣置换术。77例行三尖瓣环成形术，2例行三尖瓣置换术，1例行左上腔静脉结扎术，3例房颤患者行射频消融治疗。原发孔房间隔缺损患者行自体心包改良Kirklin修补术。其中，46例患者的冠状窦间隔被分离至左心房，41例患者的冠状窦保留在右心房。比较冠状窦被分离至左心房的患者与冠状窦保留在右心房的患者的指尖血氧饱和度。
术后1例（1.15%）因呼吸衰竭早期死亡，1例（1.15%）发生三度房室传导阻滞并植入永久性起搏器。左心房组术前指尖血氧饱和度为96.81±3.17，术后7天为95.37±4.62，术后3个月为94.53±4.95。右心房组术前为98.53±2.84，术后7天为97.19±3.57，术后3个月为96.89±4.19。在3个月至7年的随访期内，心功能得到充分恢复。
轻度低温体外循环心脏跳动手术是一种安全可行的方法。冠状窦保留在右心房可能维持血氧饱和度。
