胸骨正中切口一期矫治主动脉弓中断
One-stage repair of interrupted aortic arch through midline sternotomy
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摘要: 目的: 回顾总结主动脉弓中断经胸骨正中切口一期矫治的方法、疗效。方法: 8例患者中,男性5例,女性3例,手术年龄1~11岁,体重9~21kg。其中A型7例,B型1例,8例均合并其他心血管畸形和重度肺动脉高压,均经正中胸骨切口一期矫治。结果: 全组死亡1例,死于术后严重低心排综合征及肾功能衰竭,随访6例,6~14年,无晚期死亡。其中1例术后12年发生同种血管钙化、狭窄,压差12kPa,再次行人工血管连接升主动脉至腹主动脉旁路移植术,1例主动脉吻合口压差5.3kPa,其余主动脉吻合口压差为1.3~3.3kPa,心功能NYHAⅠ级。结论: 主动脉弓中断经胸骨正中切口一期手术矫治尤其是主动脉直接吻合的方法操作简便,暴露良好,创伤小,有利于术后恢复。Abstract: Objective: To summarize the experience with one-stage repair of interrupted aortic arch(IAA) through midline sternotomy. Methods: Eight patients (male5,female3) with IAA were operated. The age of surgical operation was 1-11 years and body weight was 9-21kg, five patients were tape A IAA and 1 was type B. All patients had associated cardiac anomalies and severe pulmonary hypertension. Results: There was one early death as a result of severe low cardiac output syndrome combined with acute renal failure. The 6 survivors were followed up from 0.5-14 years,and no late death. One patient required a bypass with artificial graft between ascending aorta and descending aortic artery who had aortic homograft calcification and residual pressure gradient 12kPa after 12 years′ discharge. One had residual pressure gradient 5.3kPa.The other 4 patients had 1.3-3.3kPa, but their cardiac function was NYHA Ⅰ. Conclusion: The method of one-stage repair of IAA especially with direct end-end anastomosis through midline sternotomy can achieve good exposure, less trauma and excellent recuperation.
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