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《国际心血管病杂志》[ISSN:1006-6977/CN:61-1281/TN]

期数:

2018年02期

页码:

94-97

栏目:

临床研究

出版日期:

2018-03-25

文章信息/Info

Title:

Immediate and middle-term outcome of modified Nikaidoh operation for transposition of great arteries or double-outlet right ventricle with ventricular septal defect and pulmonary stenosis

作者:

宋杰; 张达雄

430022 武汉亚洲心脏病医院心外科

Author(s):

SONG Jie;  ZHANG Daxiong.

Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Hubei 430022, China

关键词:

Nikaidoh术;  大动脉转位;  右室双出口;  肺动脉狭窄;  室间隔缺损

Keywords:

Nikaidoh operation;  Transposition of great arteries;  Double-outlet right ventricle;  Pulmonary stenosis;  Ventricular septal defect

分类号:

-

DOI:

10.3969/j.issn.1673-6583.2018.02.008

文献标识码:

-

摘要:

目的:观察改良Nikaidoh术治疗大动脉转位(TGA)或右室双出口(DORV)合并室间隔缺损(VSD)、肺动脉狭窄(PS)的早中期随访结果。方法:2007年1月至2016年12月在武汉亚洲心脏病医院共行改良Nikaidoh手术34例,其中22例为TGA/VSD/PS,12例为DORV/VSD/PS,患者中位年龄1.5岁(3个月～26岁),中位体质量11 kg(6～42 kg)。手术均以改良Nikaidoh术为主要术式。结果:平均体外循环时间(160±46)min,主动脉阻断时间(119±36)min,重症监护室滞留时间(120±45)h,住院时间(18±11)d。早期死亡3例,延迟关胸6例,严重并发症7例(开胸止血3例、Ⅲ度房室传导阻滞1例、室间隔中等大小残余分流1例、单侧膈肌麻痹1例、因肺动脉瓣严重反流而置换牛颈静脉管道1例)。随访中位时间64个月(9～115个月),1例因PS、右心衰竭于术后第8年再次手术后死亡; 其余30例均未行二次手术,临床心功能Ⅰ～Ⅱ级,无左、右室流出道进行性梗阻病例,无冠状动脉缺血表现,无中度以上主动脉瓣反流,1例肺动脉瓣重度反流。结论:改良Nikaidoh术治疗合并VSD和PS的心室大动脉连接异常,并不增加围术期死亡率,中期随访效果满意,可作为首选术式。

Abstract:

Objective:To investigate the immediate and middle-term outcome of modified Nikaidoh operation for transposition of great arteries(TGA)or double-outlet right ventricle(DORV)with ventricular septal defect(VSD)and pulmonary stenosis(PS).Methods:Thirty-four hospitalized cases who underwent modified Nikaidoh operation in Wuhan Asia Heart Hospital from January. 2007 to December. 2016 were included in the study. Twenty-two were diagnosed as TGA/VSD/PS, the others were DORV/VSD/PS. The median age at operation was 1.5 years old(3 months to 26 years old)and the median body weight was 11 kg(6 to 42 kg).Results:There were 3 hospital deaths, 6 delayed sternal closures and 7 severe complications, which included 3 postoperative hemostasis by thoracotomy, 1 complete atrioventricular block, 1 medium-size residual shunt in interventricular septum, 1 diaphragmatic paralysis and 1 replacement of bovine jugular vein conduit due to severe pulmonary regurgitation. At a median follow-up of 64 months(9 to 115 months), one patient accepted second operation due to PS and right heart failure 8 years after opertion and died, the other 30 cases were all alive and free from reoperation. All cases have cardiac function grade Ⅰ～Ⅱ. There was no patient with progressive obstruction of left or right ventricular outflow tract, manifestation of coronary ischemia and over middle degree aortic regurgitation, while 1 case had severe pulmonary regurgitation.Conclusions:Modified Nikaidoh operation for TGA/VSD/PS or DORV/VSD/PS could be the first choice for these kinds of congenital heart disease due to satisfactory mid-term outcome with no increase of perioperatine mortality.

参考文献/References

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备注/Memo

备注/Memo:

通信作者: 张达雄,Email:zhangdax692@126.com

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更新日期/Last Update: 2018-04-20