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[不完全性房室通道的手术治疗。128例患者的中期随访]

[Surgery for incomplete atrioventricular canal. Mid-term follow-up apropos of 128 patients].

作者信息

Houyel L, Petit J, Langlois J, Nottin R, Planche C, Binet J P

机构信息

Centre chirurgical Marie-Lannelongue, Le Plessis-Robinson.

出版信息

Arch Mal Coeur Vaiss. 1988 Apr;81(4):501-5.

PMID:3136711
Abstract

Among 128 consecutive patients operated upon between 1972 and 1984 at the Marie-Lannelongue Surgical Centre for incomplete persistent atrioventricular canal, 102 could be followed up for periods ranging from 18 months to 11 years. Of the 23 patients lost sight of, 19 were foreigners. One patient died during the first postoperative month and two died during the following five months; there was no death thereafter. One patient developed complete atrioventricular block immediately after surgery. At the end of the follow-up period, three patients had been reoperated upon for disinsertion of the patch on the ostium primum associated in one case with massive mitral regurgitation; two complete atrioventricular blocks requiring permanent pacing had occurred some time after surgery; five patients had presented with late atrial dysrhythmia, and only six patients had signs of heart failure primarily due to residual mitral regurgitation. At radiography, the cardiothoracic ratio was reduced in 74 p. 100 of the cases from 0.60 +/- 0.08 to 0.53 +/- 0.05 (p less than 0.001), and the earlier the operation had been performed, the greater the reduction in cardiothoracic ratio (p less than 0.05). A mitral regurgitation murmur was observed in 72 p. 100 of patients immediately after surgery and in 82 p. 100 of patients at the end of the follow-up period. The murmur was usually weak (79 p. 100) with a tendency to remain stable (44 p. 100) or to increase in intensity (43 p. 100, but reoperation was necessary in only one case.(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

1972年至1984年间,在玛丽 - 拉讷隆格外科中心对128例连续性不完全性永存房室通道患者进行了手术,其中102例获得随访,随访时间从18个月至11年不等。在失访的23例患者中,19例为外国人。1例患者在术后第一个月死亡,2例在随后的五个月内死亡;此后无死亡病例。1例患者术后立即出现完全性房室传导阻滞。随访期末,3例患者因原发孔补片脱开再次手术,其中1例合并大量二尖瓣反流;术后一段时间出现2例完全性房室传导阻滞,需要永久性起搏;5例患者出现晚期房性心律失常,仅6例患者有主要因残余二尖瓣反流导致的心力衰竭体征。X线检查显示,74%的病例心胸比率从0.60±0.08降至0.53±0.05(p<0.001),手术时间越早,心胸比率降低越明显(p<0.05)。术后即刻72%的患者可闻及二尖瓣反流杂音,随访期末82%的患者可闻及。杂音通常较弱(79%),倾向于保持稳定(44%)或强度增加(43%),但仅1例需要再次手术。(摘要截选至250字)

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