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目的总结法洛四联症和右室双出口合并冠状动脉畸形手术治疗经验,探讨冠状动脉畸形对右室流出道重建的影响。方法1989年4月至2004年5月治疗合并冠状动脉畸形的法洛四联症和右室双出口患儿20例,其中单支冠状动脉畸形11例,左前降支起自右冠状动脉6例,右冠状动脉肺动脉瘘2例,左右冠状动脉交通支形成蔓状血管丛1例。行姑息手术1例,根治术19例。结果根治术早期死亡1例,18例随访10个月至8年,残余漏2例,残余梗阻3例,余结果满意。结论根据畸形冠状动脉走行特点,选择手术切口,避免损伤异常冠状动脉。有些术中被迫使用异体材料或无法行根治术,影响了中远期效果,应引起足够重视。
Objective To summarize the experience of surgical treatment of tetralogy of Fallot and double outlet right ventricle combined with coronary artery disease and to explore the effect of coronary artery malformation on the reconstruction of right ventricular outflow tract. Methods From April 1989 to May 2004, 20 patients with tetralogy of Fallot and double outlet right ventricle were treated with coronary artery malformation. Among them, 11 cases were single coronary artery malformation, 6 cases were left anterior descending coronary artery from right coronary artery , 2 cases of right coronary artery pulmonary artery fistula and 1 case of left and right coronary artery branch. Line palliative surgery in 1 case, radical surgery in 19 cases. Results 1 died of early radical operation, 18 cases were followed up for 10 months to 8 years, residual leakage in 2 cases, residual obstruction in 3 cases, the remaining results were satisfactory. Conclusion According to the characteristics of coronary artery deformity, choose surgical incision to avoid damage to abnormal coronary artery. Some patients were forced to use allogeneic materials or can not be radical surgery, affecting the long-term results should be paid enough attention.