Schmid F X, Morales M, Stark J
Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, England.
Ann Thorac Surg. 1995 Jan;59(1):201-4. doi: 10.1016/0003-4975(94)00773-Z.
Progressive or recurrent left ventricular outflow tract obstruction after a previous Mustard or Senning operation represents a rare but challenging problem. The obstruction can be resected in some patients, but abnormal attachment of the mitral valve or a long fibromuscular tunnel represents a difficult surgical problem. Between 1979 and 1993, we encountered this type of left ventricular outflow tract obstruction in 10 patients, 4 to 13 years after the atrial repair. They ranged in age from 5 to 15 years (mean, 8.8 years) and weighed between 11.5 and 47 kg (mean, 25.3 kg). Operations were performed through a left thoracotomy with the patient on hypothermic cardiopulmonary bypass but without aortic cross-clamping. The left atrial appendage and descending aorta were cannulated. Good relief of the gradient was obtained in all patients (mean residual gradient, 14.8 mm Hg). All patients survived the operation. One patient died suddenly at home 6 months later; 2 patients required conduit replacement. All 9 long-term survivors are asymptomatic as of 6 months to 8 years after their conduit placement or replacement. We recommend the placement of a left ventricle-to-pulmonary artery valved conduit for the relief of severe left ventricular outflow tract obstruction arising after a Senning or Mustard operation that cannot be managed by other means.
在先前的Mustard或Senning手术后出现进行性或复发性左心室流出道梗阻是一个罕见但具有挑战性的问题。在一些患者中可以切除梗阻部位，但二尖瓣的异常附着或长纤维肌性隧道是一个棘手的外科问题。1979年至1993年间，我们在10例患者中遇到了这种类型的左心室流出道梗阻，发生在心房修复术后4至13年。他们的年龄在5至15岁之间（平均8.8岁），体重在11.5至47千克之间（平均25.3千克）。手术通过左胸切口进行，患者接受低温体外循环，但不进行主动脉阻断。左心耳和降主动脉插管。所有患者的压差均得到良好缓解（平均残余压差为14.8毫米汞柱）。所有患者均手术存活。1例患者术后6个月在家中突然死亡；2例患者需要更换管道。截至管道置入或更换后6个月至8年，所有9例长期存活者均无症状。我们建议放置左心室至肺动脉带瓣管道，以缓解Senning或Mustard手术后出现的严重左心室流出道梗阻，而其他方法无法处理这种梗阻。
