天津医药 ›› 2017, Vol. 45 ›› Issue (12): 1257-1260.doi: 10.11958/20170672

• 临床研究 • 上一篇    下一篇

Hybrid 技术治疗心脏复杂畸形合并肌部 室间隔缺损的临床观察

刘菁菁 1, 2, 王强 2, 刘建实 1, 2△   

  1. 作者单位: 1 天津医科大学 (邮编 300070); 2 天津市胸科医院 作者简介: 刘菁菁 (1989), 女, 本科, 主要从事小儿心脏外科研究 △通讯作者 E-mail: jianshiliu@aliyun.com
  • 收稿日期:2017-06-09 修回日期:2017-09-15 出版日期:2017-12-15 发布日期:2017-12-15
  • 通讯作者: 刘建实 E-mail:jianshiliu@alilyun.com

Clinical observation of Hybrid therapy in repairing muscular ventricular septal defect associated with additional congenital heart disease

LIU Jing-jing1,2, WANG Qiang2, LIU Jian-shi1,2△   

  1. 1 Tianjin Medical University, Tianjin 300070, China; 2 Tianjin Chest Hospital △Corresponding Author E-mail: jianshiliu@aliyun.com
  • Received:2017-06-09 Revised:2017-09-15 Published:2017-12-15 Online:2017-12-15

摘要: 目的 探讨 Hybrid 技术在治疗儿童心脏复杂畸形合并肌部室间隔缺损 (mVSD) 的疗效。方法 回顾性分 析 2010 年 12 月—2016 年 12 月我院收治的 18 例 (男 9 例, 女 9 例) 复杂心脏畸形伴 mVSD 患儿的临床资料。复杂 心脏畸形主要包括: 法洛氏四联征、 主动脉弓缩窄、 完全性大动脉转位、 右心室双出口、 二尖瓣裂等。全组均在体外 循环心内直视下行复杂畸形Ⅰ期解剖矫治及镶嵌封堵术。结果 术后 4 例患者死亡, 1 例因术后感染, 1 例因复杂 畸形未能修复, 1 例因封堵器移位致二尖瓣损伤, 1 例因不明原因心律失常。1 例由于存在巨大膜部室间隔缺损行Ⅰ 期手术时未发现肌部室缺, 行非计划再次手术。余患儿均完成Ⅰ期手术矫治后顺利出院。随访(1 个月~5 年)无死 亡。14 例患儿中 14 例封堵器位置良好, 12 例无明显残余分流, 13 例心功能正常(射血分数 0.63±0.05)。结论 Hybrid 治疗 mVSD 安全、 有效, 尤其适用于合并其他心内、 外复杂畸形的患儿或复杂血管情况的患者。

关键词: 心脏缺损, 先天性, 室间隔缺损, 心脏外科手术, 镶嵌治疗

Abstract: Objective To discuss the clinical efficacy of Hybrid therapy in repairing muscular ventricular septal defect (mVSD) associated with additional congenital heart disease in children. Methods The clinical data of 18 patients (9 males and 9 females) admitted to our hospital from December 2012 to December 2016 were retrospectively analyzed. The mainly additional congenital heart diseases were tetralogy of fallot, coarctation of aorta, complete transposition of great arteries, double outlet right ventricle, mitral valve cleft. All of the patients were treated with corrective surgeries of Hybrid therapy under direct supervision. Results Four patients died through the operation. One patient died of postoperative infection, 1 patient died of the complex malformation, which wasn′ t repaired, 1 patient died of mitral valve damage for occluder device replacement, 1 patient died of arrhythmia with unknown reason. One patient received non planned reoperation because of the huge membranous ventricular septal defect for the first stage surgery, in which no mVSD was found. All the rest patients were completed their first stage treatment and discharged from hospital. During the followed ups (1 month to 5 years), no patient died. The occluder devices were in correct position in 14 patients, no residual shunt was found in 12 cases. The cardiac function was normal in 13 cases [ejection fraction (EF)=0.63±0.05]. Conclusion It is safe and effective for the treatment of mVSD using Hybrid therapy, which is especially suitable for patients with complex cardiac malformations and patients with complicated vascular situation.

Key words: heart defects, congenital, heart septal defects, ventricular, cardiac surgical procedures, Hybrid therapy