Singh A K, de Leval M R, Stark J
Ann Surg. 1977 Nov;186(5):577-80. doi: 10.1097/00000658-197711000-00006.
Closure of muscular ventricular septal defects (VSDs) through the right atriotomy or right ventriculotomy may be difficult. These VSDs are often located behind the hypertrophied trabeculae carnae or papillary muscle. Residual or recurrent VSD may result from the difficult approach. Between March 1971 and December 1975, we have used the left ventriculotomy near the apex for closure of muscular VSDs in ten children. The patients' ages ranged from five months to eight years and three months. The diagnosis was established by cardiac catheterisation and left ventricular angiocardiogram in all patients. Six patients had multiple VSDs; in four patients VSD in the muscular septum was present (three apical, one midseptal). Operations were performed on cardiopulmonary bypass with moderate hypothermia and intermittent anoxic arrest. VSDs in the membranous septum were closed through the right atrium. Muscular VSDs were approached through a small vertical incision in the left ventricle near the apex. The postoperative course was uneventful in eight patients. Two patients, aged 16 months and eight years, died; histology showed grade IV pulmonary vascular disease in both. All survivors are well four months to five years after the operation, without clinical evidence of residual or recurrent VSD.
经右心房切开术或右心室切开术闭合肌部室间隔缺损（VSD）可能会很困难。这些VSD通常位于肥厚的肉柱或乳头肌后方。手术入路困难可能导致残余或复发性VSD。1971年3月至1975年12月期间，我们采用心尖附近的左心室切开术为10名儿童闭合肌部VSD。患者年龄从5个月至8岁3个月不等。所有患者均通过心导管检查和左心室心血管造影确诊。6例患者有多个VSD；4例患者存在肌部室间隔VSD（3例位于心尖，1例位于室间隔中部）。手术在中度低温和间歇性缺氧停搏的体外循环下进行。膜部室间隔VSD通过右心房闭合。肌部VSD通过心尖附近左心室的小垂直切口进行处理。8例患者术后病程平稳。2例患者，年龄分别为16个月和8岁，死亡；组织学检查显示两者均有IV级肺血管疾病。所有幸存者在术后4个月至5年情况良好，无残余或复发性VSD的临床证据。
