肺动脉束带术的临床经验

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1、Indicationsofpulmonaryarterybanding(PAB)incongenitalcardiacsurgeryFuWaiCardiovascularDiseaseHospitalPediatricSurgicalCenterShouJunLiHistory1952MullerandDammannfirstlyintroducedthePABoperationInitiallyfortreatmentofcongenitalanomalieswithpulmonaryhypertensionPrimaryrepairhasreplacedPABintreatmen

2、tforPHCurrentIndicationsofPABinAdvancedCountriesStagedpalliationforphysiologicalsingleventriclewithunobstructedpulmonaryflow3-4weeksTwo-stagearterialswitchoperationBeyondtheneonatalperiodClinicalData1997-2003Total:32casesMale19,Female13Age:2months-24years,mean:33.78monthBodyweight(BW):3.25-41kg

3、,mean:10.7kgIndicationsPhysiologicalsingleventricleOtheranomalieswithunrestrictedpulmonaryflowBeyondtheneonatalperiodTGA:leftventriculartrainingTreatmentofPhysiologicalSingleVentricleSurgicalManagementStagedoperation：FirstStage:PABSecondStage:BidirectionalGlennSimultaneousOperation：Glenn+PAB(1)

4、StagedOperationPatients’Characteristics13casesAge:3-60monthsmean23.46monthsBW:4-16kgmean9.23kgSaO2:86.2±8.1%Patients’CharacteristicsSV7casesTA3casesDORVfunctionalSV2casesMA1caseIntraoperativeDataBeforePABPAP:38.82±10.04mmHgSaO2:86%±20.8%AfterPABPAP:25.92±6.65mmHgSaO2:80.27%±7.7%ResultsPAPdecrea

5、sesatisfactorily:8casesSecondstageGlenn:2casesSecondstageBjork:1casesThirdstageTCPC:1caseOperationinterval:1-2yearsWaitingforfurtherstagetreatment:4casesResultsPAPdecreaseunsatisfactorily:5casesRedoPAB:1caseThird-timePAB:1caseUntreated:3cases(2)SimultaneousPAB+GlennPatients’Characteristics6case

6、sAge:1-24yearsBW:8-41kg,mean21.5kgSaO2:73±7.0%Patients’CharacteristicsDORV+PS:3casesSV+PS:1caseECD+C-TGA+PS:1case(PAPgradient70.5±11mmHg,UCG)TA1case(PA=35/20(30)mmHgcatheterization)IntraoperativeDataBeforePABPAP:19.33±4.53mmHSaO2:89%±6.0%AfterPABPAP:15.50±4.0mmHgSaO2:87.3%±5%ResultsAllthese6pat

7、ientsrecovereduneventfullyandwithoutmajorcomplicationDiscussionPAP>19mmHgPAB+GlennsimultaneouslyPostoperativePAP15mmHgModeratePH（PAP38mmHg）StagedPABfollowedbyGlennorFontanNodeathandmajorcomplicationinthiscohortSVpatientsOtherAnoma