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目的总结心室内隧道法手术纠治右室双出口(DORV)并主动脉瓣下VSD的经验。方法回顾性分析本院2000年1月-2009年11月17例DORV并主动脉瓣下VSD患儿采用心室内隧道法纠治的临床资料。男12例,女5例;手术年龄1～14岁;体质量6～47kg。术前诊断依据为心脏多普勒超声、心血管造影等检查。其中艾森曼格型11例,法洛四联症型6例。手术均于全麻低温体外循环下行心室内隧道修复,经右心室切口用涤纶补片做内隧道将左室血通过VSD引至主动脉,补片扩大右室流出道或进行肺动脉跨环补片。术后常规予多巴胺或多巴酚丁胺2.5～8.0μg·kg-1.min-1,1～10d,心率较慢者加用异丙肾上腺素,临床低心排较重者加用肾上腺素。结果早期1例患儿死于低心排综合征,余16例均恢复良好,超声心动图示心室内隧道通畅,无残余分流。结论心室内隧道法是纠治DORV并主动脉瓣下VSD的满意术式。
Objective To summarize the experience of ventriculo-tunnel surgery in the treatment of right ventricular dual outlet (DORV) and aortic valve VSD. Methods A retrospective analysis of 17 cases of DORV and aortic valve in children with heart disease in our hospital from January 2000 to November 2009 were retrospectively analyzed. There were 12 males and 5 females. The operative age ranged from 1 to 14 years and the body weight ranged from 6 to 47 kg. Preoperative diagnosis based on the heart Doppler ultrasound, cardiovascular imaging and other tests. Among them, 11 cases of Eisenman’s syndrome and 6 cases of tetralogy of Fallot. Surgical operations were performed undergoing general anesthesia with hypothermic cardiopulmonary bypass. Intraventricular tunnel repair was performed. The right ventricle incision was made with a dacron patch inside the tunnel to lead left ventricular blood to the aorta through the VSD. The patch expanded the right ventricular outflow tract or the pulmonary artery . Postoperative conventional dopamine or dobutamine 2.5 ~ 8.0μg · kg-1.min-1 ~ 10d, with slower heart rate plus isoproterenol, clinical low cardiac output plus adrenaline . Results One patient died of low cardiac output syndrome in the early stage, and the other 16 patients recovered well. Echocardiography showed ventricular tunnel unobstructed and no residual shunt occurred. Conclusions Intraventricular tunneling is a satisfactory surgical procedure for correcting DORV and aortic valve.