Wen Bing, Yang Junya, Liu Huiruo, Jiao Zhouyang, Zhao Wenzeng
Bing Wen, Department of Cardiovascular Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Junya Yang, Department of Dermatological, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Pak J Med Sci. 2016 May-Jun;32(3):539-44. doi: 10.12669/pjms.323.9872.
To document clinical experience of treating congenital heart disease combined with large patent ductus arteriosus with pulmonary artery closure in combination with patch technique.
Thirty-six patients (8 males and 28 females) who suffered from congenital heart disease and underwent hybrid surgery in the First Affiliated Hospital of Zhengzhou University from October 2010 to February 2014 were selected for this study. They aged 14 to 39 years and weighed 32.20 to 61.50 kg. Diameter of arterial duct was between 10 mm and 13 mm; 28 cases were tube type, 4 cases were funnel type and four cases were window type. All patients had moderate or severe pulmonary arterial hypertension; besides, there were 28 cases of ventricular septal defect, 16 cases of atrial septal defect, eight cases of aortic insufficiency, four cases of mitral stenosis and insufficiency and four cases of infectious endocarditis. Cardz Pulmonary Bypass (CPB) was established after chest was opened along the middle line. With the help of Transesophageal echocardiography, large patent ductus arteriosus was blocked off through pulmonary artery. Pulmonary artery was cut apart after blocking of heart. Large patent ductus arteriosus on the side of pulmonary artery was strengthened with autologous pericardial patch.
Of 36 patients, 32 patients had patent ductus arteriosus closure device and four patients had atrial septal defect closure device. Pulmonary arteries of 36 cases were all successfully closed. Systolic pressure declined after closure ((54.86±19.23) mmHg vs (96.05±23.07) mmHg, p<0.05); average pulmonary arterial pressure also declined after closure ((39.15±14.83) mmHg vs (72.88±15.76) mmHg, p<0.05). The patients were followed up for one to fifty one months (average 11.5 months). Compared to before surgery, left atrial diameter, left ventricular diameter and pulmonary artery diameter all narrowed after surgery. Besides, clinical symptoms were relieved and cardiac function of the patients also improved.
Hybrid surgery is feasible and safe in treating patients with large patent ductus arteriosus and congenital heart disease, which decreases surgical problems, shortens surgical time and lowers the incidence of complications.
记录采用肺动脉闭合联合补片技术治疗先天性心脏病合并粗大动脉导管未闭的临床经验。
选取2010年10月至2014年2月在郑州大学第一附属医院接受杂交手术的36例先天性心脏病患者（男8例，女28例）进行研究。年龄14～39岁，体重32.20～61.50 kg。动脉导管直径10～13 mm；管型28例，漏斗型4例，窗型4例。所有患者均有中度或重度肺动脉高压；此外，室间隔缺损28例，房间隔缺损16例，主动脉瓣关闭不全8例，二尖瓣狭窄并关闭不全4例，感染性心内膜炎4例。沿中线开胸后建立体外循环。在经食管超声心动图的辅助下，经肺动脉阻断粗大动脉导管未闭。心脏阻断后切开肺动脉。用自体心包补片加强肺动脉侧的粗大动脉导管未闭。
36例患者中，32例置入动脉导管未闭封堵器，4例置入房间隔缺损封堵器。36例肺动脉均成功闭合。闭合后收缩压下降（（54.86±19.23）mmHg对（96.05±23.07）mmHg，p<0.05）；平均肺动脉压闭合后也下降（（39.15±14.83）mmHg对（72.88±15.76）mmHg，p<0.05）。患者随访1～51个月（平均11.5个月）。与术前相比，术后左心房内径、左心室内径和肺动脉内径均变窄。此外，临床症状缓解，患者心功能改善。
杂交手术治疗粗大动脉导管未闭合并先天性心脏病可行且安全，可减少手术问题，缩短手术时间，降低并发症发生率。
