目的 探讨胸部正中小切口在婴幼儿先天性心脏病手术治疗中的可行性及效果。 方法 将我院 2016 年 5 月至 2016 年 10 月 170 例行手术治疗的常见先天性心脏病婴幼儿患者分为两组：常规组，85 例，男42例、女43例，年龄（6.9±2.1）个月，采用常规胸部正中切口；小切口组，85 例采用胸部正中小切口，男43例、女42例，年龄（6.4±1.8）个月。小切口手术切口于平第 3 肋间切开，止于剑突起始处上 0.5 cm，刚好放入小胸骨撑开器为好。 结果 两组患儿体外循环时间差异无统计学意义（P>0.05）。小切口组手术时间略长（P<0.05）。两组预后没有差别，但是小切口组伤口长度显著缩短[（7.8±0.8） cmvs. （4.0±0.5）cm，P<0.05]。 结论 正中小切口基本具有胸骨正中切口的优点，可显露心脏各部位，满足绝大部分心脏探查和手术操作需要，必要时仍可向上延长切口使心内操作不受限制等优点，故认为正中小切口在婴幼儿心脏手术中具有良好的安全性和美观性。
ObjectiveTo study the diagnosis and treatment of aortopulmonary window (APW) associated with severe pulmonary hypertension.MethodsThe clinical data of 23 patients with APW undergoing surgical treatment in The First Affiliated Hospital of Air Force Medical University from 2010 to 2018 were retrospectively reviewed. There were 9 male and 14 female patients. The age was 3-132 (4.63±2.14) months. The weight was 3.3-35.0 (17.3±3.6) kg.ResultsWindows were situated in the proximal of semilunar valve (type Ⅰ) in 8 patients, and distal of the aorta (type Ⅱ) in 14 patients, from proximal to distal (type Ⅲ) in only 1 patient. Eleven patients were isolated APW, the others were combined with cardiac defects. The mean pulmonary artery pressure was 68.4±7.5 mm Hg. All patients underwent surgical correction under general anesthesia and hypothermia cardiopulmonary bypass. All patients were discharged uneventfully, with an average follow-up time of 4 years. The patients showed good outcomes and no residual shunt after surgery, and the pulmonary artery pressure decreased to normal.ConclusionAPW is an uncommon congenital cardiac anomaly. The clinical presentation is an excessive left-to-right shunt, and most patients present early in life. Development of pulmonary hypertension and pulmonary vascular resistance is usually rapid. Operative treatment is indicated as soon as the diagnosis is established, regardless of the patient’s age, and most patients after surgery have a good long-term outcome.