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|本期目录/Table of Contents|

应用再植技术治疗起源异常左冠状动脉的效果分析

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2014年第4期
页码:
433-436
栏目:
临床研究
出版日期:
2014-04-25

文章信息/Info

Title:
Reimplantation technique for management of anomalous left coronary artery from pulmonary artery
作者:
尹朝华; 闫 军; 李守军; 沈向东; 王 强; 李巅远
(中国医学科学院、中国协和医科大学、阜外心血管病医院心外科，北京 100037)
Author(s):
YIN Zhao-hua;  YAN Jun;  LI Shou-jun;  SHEN Xiang-dong;  WANG Qiang;  LI Dian-yuan
(Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, China)
关键词:
左冠状动脉异常; 起源于肺动脉：二尖瓣关闭不全; 心脏外科手术
Keywords:
anomalous left coronary artery from the pulmonary artery;  mitral regurgitation;  cardiac surgical procedure
分类号:
R543.3
DOI:
-
文献标识码:
A
摘要:
目的:分析和讨论应用冠状动脉再植技术治疗先天性起源于肺动脉的左冠状动脉异常（ALCAPA)的外科治疗效果和经验。方法： 回顾分析2008年4月~2013年4月26例应用冠状动脉再植技术治疗先天性ALCAPA患儿的临床资料。其中男14例，女12例；年龄4月~6岁。术前均经超声心动图，CT和或心血管造影检查明确诊断。结果： 术前左室射血分数(LVEF)20~80（48±18）%，心胸比0.54~0.77（0.64±0.07）。并发二尖瓣关闭不全（MI）轻度以上21例，其中中度以上17例。左心室心尖部室壁瘤1例，房间隔缺损1例。同期行二尖瓣成形11例，室壁瘤切除1例，房间隔缺损修补1例 。本组患儿手术均顺利完成，无手术死亡。体外循环时间91~238（150±37） min，心肌阻断时间64~200（126±36） min。 随访1~61（29±19）月，患儿无远期死亡。最后一次随诊LVEF 35~75（64±11）%，心胸比0.48~0.65（0.57±0.05），较术前明显改善。MI中度以下24例。结论： 冠状动脉再植技术手术效果良好，对于中度以上MI应积极治疗。
Abstract:
AIM:To discuss the experience of reimplantation technique for the management of anomalous left coronary artery from the pulmonary artery (ALCAPA). METHODS: Twenty-six ALCAPA patients (14 males and 12 females aged 4 months to 6 years) underwent aortic reimplantation between April 2008 and April 2013 and were retrospectively reviewed. Preoperative diagnoses were established by transthoracic echocardiography, computed tomography and/or coronary angiography. Preoperative left ventricular ejection fraction (LVEF) was 20.0-80.0(48±18)%, cardiothoracic ratio (C/T) was 0.54-0.77(0.64±0.07), and preoperative degree of mitral regurgitation (MR) was none in five patients, mild in four, moderate in ten and severe in seven patients. One patient had left ventricular apical aneurysm and one patient had atrial septal defect (ASD). Eleven patients had concomitant mitral valve surgery. Aneurysm resection and ASD closure were additionally performed, respectively, in two patients. RESULTS: The operation was successful in all patients, with cardiopulmonary bypass time from 91 to 238(150±37) min and aortic cross-clamp time from 64 to 200 (126±36) min. No death occurred during the 1- to 61-month follow-up and the last follow-up showed that LVEF was 35-75(64±11)%, C/T was 0.48-0.65(0.57±0.05), significantly improved compared with preoperative and mitral regurgitation was below moderate in 24 patients. CONCLUSION: The implantation technique produces good results for anomalous left coronary artery from the pulmonary artery and we recommend surgical repair of moderate and severe MR at the time of ALCAPA procedure.

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备注/Memo

备注/Memo:
收稿日期：2013-10-21.通讯作者：闫军，主任医师，主要从事心血管外科临床研究 Email：yanjun.111z@aliyun.com 作者简介：尹朝华，主治医师，博士 Email：cams_yinzhaohua@sina.com
更新日期/Last Update: 2014-05-06