Wang Guanxi, Liu Rui, Ma Kai, Zhang Benqing, Pang Kunjing, Qi Lei, Hua Zhongdong, Li Shoujun
Department of Pediatric Center, Fuwai Hospital, Beijing, People's Republic of China.
Cardiol Young. 2021 May;31(5):799-803. doi: 10.1017/S1047951120004643. Epub 2021 Jan 28.
The research was to introduce the experience of doubly committed subarterial ventricular septal defect (DCVSD) repaired through tricuspid approach.
From January, 2015 to September, 2019, 86 consecutive DCVSD paediatrics underwent repair via right subaxillary vertical incision (RAVI) through tricuspid approach. Perioperative and follow-up data were collected.
The age and weight at operation were 28.1 ± 18.5 (range: 7-101) months and 12.2 ± 4.2 (6-26.5) kg. There were two patients combined with discrete subaortic membrane, two patients with patent ductus arteriosus, one patient with atrial septal defect, and two patients with abnormal muscle bundle in right ventricular outflow tract. The mean size of ventricular septal defect was 7.0 ± 2.4 (3-13) mm. The defect was repaired with a piece of Dacron patch in 68 patients or directly with 1-2 pledgetted polypropylene sutures in 18 patients. The cardiopulmonary bypass time and aortic cross-clamp time were 46.2 ± 13.3 (23-101) minutes and 29.2 ± 11.5 (12-84) minutes. After 3.1 ± 2.4 (0-14) hours' ventilator assist and 23.2 ± 32.1 (0-264) hours' ICU stay, all patients were discharged safely. At the latest follow-up (27.9 ± 14.6 months), echocardiography showed trivial residual shunt in two patients. There was no malignant arrhythmia occurred and there was no chest deformity or asymmetrical development of the breast was found.
DCVSD repaired via right subaxillary vertical incision through tricuspid approach was safe and feasible, providing a feasible alternative to median sternotomy, and it can be performed with favourable cosmetic results.
本研究旨在介绍经三尖瓣入路修复双动脉下室间隔缺损（DCVSD）的经验。
2015年1月至2019年9月，86例连续性DCVSD患儿经右腋下垂直切口（RAVI）通过三尖瓣入路进行修复。收集围手术期和随访数据。
手术时年龄和体重分别为28.1±18.5（范围：7 - 101）个月和12.2±4.2（6 - 26.5）千克。有2例患者合并有孤立性主动脉瓣下隔膜，2例动脉导管未闭，1例房间隔缺损，2例右心室流出道肌束异常。室间隔缺损平均大小为7.0±2.4（3 - 13）毫米。68例患者用一块涤纶补片修复缺损，18例患者直接用1 - 2根带垫片聚丙烯缝线修复。体外循环时间和主动脉阻断时间分别为46.2±13.3（23 - 101）分钟和29.2±11.5（12 - 84）分钟。经过3.1±2.4（0 - 14）小时的呼吸机辅助和23.2±32.1（0 - 264）小时的重症监护病房停留后，所有患者均安全出院。在最近一次随访（27.9±14.6个月）时，超声心动图显示2例患者有微量残余分流。未发生恶性心律失常，未发现胸部畸形或乳房不对称发育。
经右腋下垂直切口通过三尖瓣入路修复DCVSD是安全可行的，为正中胸骨切开术提供了一种可行的替代方法，且手术具有良好的美容效果。
