Search

139例肺动脉闭锁的外科治疗

Objective To sum up surgical treatment results of pulmonary atresia (PA) including 15 PA with intact ventricular septum(PA-IVS) and 124 PA with ventricular septum defects (PA-VSD) and to explore the optimal time, technique and risk factors of operation. Methods From Apr. 1992 to Jun. 2002, 139 patients with PA consecutive underwent surgical treatment. Among the 124 patients PA-VSD, 75 patients underwent one-stage radical operation and 10 patients accepted two-stage ones under hypothermic anesthesia with cardiopulmonary bypass(CPB), 39 patients underwent palliative operation. 15 patients were PA-IVS, 9 patients underwent one-stage radical operation with mean Z value -0.4±0.8, and 6 patients underwent palliative operation with mean Z value -1.5±0.7. Ligation and interventional embolization carried out in the patients supplied with major aortopulmonary collateral arteries(MAPCA) and patent ductus arteriosus(PDA). Unifocalization operation in patients supplied with MAPCA. Results 23 patients died in perioperative period. The operative mortality was 16.5%. Other patients were cured after operation. The pulmonary artery index(PAI) of 22 dead patients PA-VSD were less than 150 mm2/m2. One patient of PA-IVS underwent central palliative procedures died of hypoxemia. The risk factor of operations were time of CPB and body weight. Conclusions An early operation on patients with PA can be accomplished with satisfactory outcomes. It is feasible to evaluate indications of operation and choose radical or palliative procedures according to PAI(gt;150 mm2/m2) in patients with PA-VSD. The optimal technique of patients with PA-IVS should be dicided by Z value and size of right ventricle.