Di Bella I, Gladstone D J
Department of Cardiac Surgery, Royal Group of Hospitals, Belfast, Northern Ireland.
Ann Thorac Surg. 1998 Mar;65(3):768-70. doi: 10.1016/s0003-4975(97)01418-5.
Aortopulmonary window is a rare anomaly, and a variety of surgical techniques have been described for its closure.
We treated 6 infants with aortopulmonary window between 1993 and 1995. Three had associated type A interrupted aortic arch, and another had a muscular ventricular septal defect. The diagnosis was made by echocardiography, confirmed by cardiac catheterization in 4 infants. In 1 very sick neonate with interrupted arch, diagnosis of the window was considerably delayed. In 4 patients, we closed the window by using a flap of pulmonary artery, which was reconstructed without using a patch. In 2 neonates with interrupted arch we anastomosed the mobilized descending aorta directly to the aortic defect of the aortopulmonary window, closing the pulmonary artery with a pericardial patch.
There were no hospital deaths, and all patients are in New York Heart Association functional class I at a mean follow-up of 30 months. Echocardiography shows no significant distortion of the great vessels.
The techniques described achieve excellent results using only autologous tissues with the potential for normal growth.
主肺动脉窗是一种罕见的先天性心脏畸形，目前已有多种手术方法用于关闭该缺损。
1993年至1995年间，我们共治疗了6例主肺动脉窗患儿。其中3例合并A型主动脉弓中断，1例合并肌部室间隔缺损。诊断主要依靠超声心动图，4例经心导管检查确诊。1例患有主动脉弓中断的重症新生儿，主肺动脉窗的诊断明显延迟。4例患者采用肺动脉瓣叶修补主肺动脉窗，未使用补片重建肺动脉。2例主动脉弓中断的新生儿，我们将游离的降主动脉直接吻合至主肺动脉窗的主动脉缺损处，并用心包补片关闭肺动脉。
无住院死亡病例，平均随访30个月时，所有患者纽约心脏协会心功能分级均为I级。超声心动图显示大血管无明显扭曲。
本文所述技术仅使用自体组织，取得了良好的效果，且具有正常生长的潜力。
