降低房室间隔缺损介入治疗失败后外科手术病死率的探讨

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1、·4·中国医师进修杂志2010年1月15日第33卷第2期ChinJPostgradMed，January152010，Vo1．33。No．2临床论著·降低房室间隔缺损介入治疗失败后外科手术病死率的探讨韩宏光张南滨汪曾炜王辉山朱洪玉李新民【摘要】目的探讨降低房室间隔缺损介入治疗失败后外科手术病死率的有效措施。方法对16例房间隔缺损(ASD)和室间隔缺损(VSD)介入治疗失败需外科手术患者的临床资料进行回顾性分析。手术均在体外循环下进行，取出封堵器，修复心内畸形。结果本组无外科手术死亡病例。ASD部

2、位为中央型5例，下腔型7例，与术前诊断相符率41．7％(5／12)，不相符率58．3％(7／l2)(尸>0．05o术后ASD直径平均(31．0±1．0)mm，较术前诊断的(26．0±2_3)mm增大(尸0．05)。3例第三度房室传导阻滞术后均恢复窦性心律，心内畸形修复完善。结论房室间隔缺损介入治疗后发生严重并发症及时采取外科手术治疗，可提高手术成功率。【关键词】房间隔缺损；室间隔缺

3、损；死亡率；介人封堵Measuresfordecreasingtheearlymortalityafteratrialseptaldefectandventricularseptaldefect、vitIlunsuccessfulinterventionaltreatmentHANHong-guang，ZHANGNan—bin，WANGZeng-wei，WANGHui-shan，ZHUHong-yu，LIXin—min．DepartmentofCardiovascularSurgery，Gene

4、ralHospitalofShenyang~litaryRegion，Shenyang110016，ChinaCorrespondingauthor：HANHong-guang，Email：hanxiyao@163．com【Abstract】ObjectiveToprobetheefectivemeasuresfordecreasingtheearlymortalityafterunsuccessfulinterventionaltreatmentforatrialseptaldefect(AS

5、D)andventricularseptaldefect(VSD)．MethodsAtotalof16patientswhounderwentsurgicaltreatmentofunsuccessfulinterventionaltreatmentforASDandVSDfromJanuary2000toDecember2007wereincludedinthisretrospectiveanalysis．Surgicalindicationwastheoccluderabscission(7

6、cases)，cardiacperforation(3cases)，t}lethirddegreeatrioventricularconductionblock(3cases)，valvularregurgitation(2cases，1easeaccompaniedwiththethirddegreeatrioventricularconductionblock)，residualshunt(1case)，unsuccessfulinterventionaltreatment(1ease)．A

7、llof16casesunderwentsurgicaltreatmentincludingremovalofthedisplacedoccluderand／orthecongenitalheartdiseaserepaired．oneardiopulmonarybypass．Aftersurgicaltreatment，allpatientsweretransferredintoICUforfurthersupervisionandtreatment．ResultsThereWasnohosp

8、italmortality．TwelveASDcaseswereperformedaftertheinterventionaltreatment，whichincluded5caseswithcentralASDand7caseswithinferiorsinusvenousASD．Coincidentalratebetweenoperatingexplorationandpreoperativediagnosiswas41．7％(5／12)．Misdiagnostieratebetweenth