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目的:探讨先天性心脏病室间隔缺损(VSD)合并中重度肺动脉高压的外科治疗及围术期处理。方法:全组108例,年龄4～96(24.5±16.8)个月,体重4.7～20(11.4±6.8)kg。均有明显临床症状。其中32例为双动脉干下型 VSD,其中4例伴有主动脉瓣脱垂和中度以上主动脉瓣返流。32例双动脉瓣下型 VSD 经肺动脉横切口,其他经右心房切口54例,右心室切口18例,另4例经右房右室双切口完成修补。结果:全组无死亡,2例发生右侧气胸,5例有左侧肺不张,无其他严重并发症。均顺利撤离呼吸机,拔除气管插管。结论:室间隔缺损合并中重度肺动脉高压的外科治疗,其成功的关键在于手术适应证掌握正确,术前准备充分,手术技术进步以及术后处理适当。
Objective: To investigate the surgical treatment and perioperative management of congenital heart disease with ventricular septal defect (VSD) complicated with moderate and severe pulmonary hypertension. Methods: The whole group consisted of 108 patients, aged from 4 to 96 (24.5 ± 16.8) months and weighing from 4.7 to 20 (11.4 ± 6.8) kg. Have obvious clinical symptoms. Among them, 32 cases were double articular trunk type VSD, of which 4 cases were accompanied by aortic valve prolapse and moderate to severe aortic valve regurgitation. Thirty-two cases of VSD underwent pulmonary artery transverse incision. The other 54 cases were performed right atrial incision, 18 cases were right ventricular incision and the other 4 cases were repaired by double incision of right atrium and right ventricle. Results: There were no deaths in the whole group, 2 cases of right pneumothorax and 5 cases of left atelectasis without other serious complications. Evacuate the ventilator smoothly, remove the tracheal intubation. CONCLUSIONS: The key to the successful surgical treatment of ventricular septal defect combined with moderate and severe pulmonary hypertension is that the operation indications are well controlled, the preoperative preparation is adequate, the surgical technique is advanced and the postoperative management is appropriate.