Gomez-Engler H E, Grunkemeier G L, Starr A
Thorac Cardiovasc Surg. 1979 Jun;27(3):160-3.
This study presents our experience in the surgical management of the newborn with critical pulmonary stenosis and intact ventricular septum. During the last decade we have seen 11 such patients, with a mean age of 2.3 days (maximum 6 days) and a mean weight of 3.6 kilograms (maximum 4.5 kilograms). The primary operation was a valvotomy in 7 patients (one of whom also had a systemic-pulmonary shunt), a commissurotomy with cardiopulmonary bypass in 3 patients, and a shunt alone in 1 patient. One infant died on the second postoperative day and another died following reoperation at 4 months. The other 9 patients were all alive and progressing satisfactorily when last seen. Five of these patients were beyond their third postoperative year and the longest survivor was at 7.9 years. Four of the long-term survivors had undergone reoperation. Our choice of operation remains transventricular valvotomy, although an open procedure utilizing cardiopulmonary bypass presents an attractive alternative. A systemic-pulmonary shunt as an addition to either of these operations is unnecessary. The perioperative use of prostaglandin E brings about substantial improvement in the early results.
本研究介绍了我们对患有严重肺动脉狭窄且室间隔完整的新生儿进行外科治疗的经验。在过去十年中，我们共诊治了11例此类患者，平均年龄为2.3天（最大6天），平均体重为3.6千克（最大4.5千克）。主要手术方式为：7例患者行瓣膜切开术（其中1例同时行了体肺分流术），3例患者在体外循环下行交界切开术，1例患者仅行分流术。1例婴儿术后第二天死亡，另1例在4个月再次手术后死亡。其他9例患者最后一次随访时均存活且病情进展良好。其中5例患者已度过术后第三年，最长存活者达7.9岁。4例长期存活者接受了再次手术。我们仍然选择经心室瓣膜切开术，尽管利用体外循环的开放手术是一种有吸引力的替代方法。作为这两种手术之一的补充，体肺分流术是不必要的。围手术期使用前列腺素E可显著改善早期治疗效果。
