Surgery that the thick artery conduit has not closed treats _'s treatment

Surgery that the thick artery conduit has not closed treats _'s treatment
Surgical treatment that the thick artery conduit has not closed

Vascular disease magazine of heart and lungs Vol. 18 of number 3 of 1999 Essay report

Author: Li WenBin Cao XiangRong Zhao GuoZhen Chen BaoTian The palace is rich

Unit: The loyal hospital (100029) is fitted in subsidiary Beijing of Capital University of Medical Sciences Department of cardiac surgery

January of 1993 of heart surgical department of our academy- Accepted for medical treatment and moved simply together in December of 1994 Pulse conduit has not been closed (PDA) 212 patients, among them thick PDA (diameter is greater than or equal to 10mm) Person 35 case.

Clinical materials 35 simple thick PDA patients, 12 men, 23 women, age 1- 69 and years old, 17.5 average years olds. Divided into 2 groups based on different operation ways: Ligature group: 3- 35 years old, 11.5 average years olds; The extracorporal circulatory system plays direct-view to sew and set up jointly: 1- 69 years old, 21 average years olds. SM2 - IV/6, P among all cases L2, rib 32Hyperfunction. 12 can smell on the intersection of apex of the heart and department SM 6, DM 6, main suit have palpitation, the intersection of person of symptom breathed hard and 6, decline the intersection of symptom person and one intentionally. X-ray examination: 2 case the intersection of lung and blood increase, 13 left room increase, 1 2 pairs of room increase. Check in electrocardiogram: The number of the left room is plump 15, the number of the right room is plump 5, plump 4 for one pair of rooms. Pursue to check in the supersound aroused in interest: The conduit diameter of artery, in above 10mm, the thickest 18mm, with the artery high pressure of lung, among them slightly (artery systolic pressure PAPs of lung: 30- 50mmHg) : 11; Intermediate (PAPs: 50- 70mmHg) : 18; Severe (PAPs> 70 mmHg) : 6. The right heart conduit is checked: There are 5 customary right heart conduit inspections in all in 35, examine and has not closed for the simple artery conduit clearly, artery high pressure of severe lung while accompanying.

Operation way and result Play direct-view and sew and set up 21 jointly outside the body, cut-out and take the spacer disconnected cotton-padded mattress type and sew and shut PDA by the lung artery under circulating outside the body. One among them because the conduit is relatively fragile, sew up the position and tear and cause the death of massive haemorrhage in the skill. The thorax accumulates 2 cases of liquid, the pericardium accumulates 1 case of liquid. Ligature is a group of 14, cut-out ligature PDA outside after left chest under general anesthesia. Nervus vagus and recurrent laryngeal nerve trend that it is left to make a clear distinction in the skill, use a pair of slow ligature when quiet to drip nitre general sodium to control systolic pressure of Line 1 0 as 70- 80mmHg, there are 5 examples after the conduit the wall adds the spacer ligature of felt. Postoperative the patients of this group have no complication, do not have death. 2 groups of patients have 23 examples (external group in all: 13, 10 of ligature group) The clinic is reexamined, all patient heart functions are good, there are an example and a few remnants that are shunted in the external group. There are not the openner ones in the ligature group.

Discussion Have cut-outed it for the first time after the ligature artery conduit of success has not been closed outside since Gross RE was in the general anesthesia, through the left chest at room temperature in 1939, this method has already become surgical therapeutic method that the clinical and commonly used artery conduit has not closed, unless (1 ) Serious calcification of the artery conduit; (2)False aneurysm takes shape; (3) Ligature is can't be more postoperative; (4) May amalgamate deformity in the heart handler meanwhile; High one hundred suitable to think at home: Danger and complication that extracorporal circulatory system is sure, choose the case to be strict, and maintain that implements the artery conduit ligature skill under the possible condition. In the this group of cases, there are more external group's patients complications, but there is not complication in the ligature group.

We divide PDA into 3 grades according to PDA diameter: Diameter 0.05) between conduit diameter and PAP of external group and ligature group in the patients of this group . But operation choose except the intersection of PDA and diameter, have the intersection of lung and the intersection of artery and the intersection of high pressure and conduit take the form of window, not thick and short older having infecting, calcification extracorporal circulatory system down and sew and close indication. If clinical manifestation cyanosis, it proves the whole lung resistance is greater than unit 10Wood that the heart conduit is checked, it is negative to test oxygen intake, rely mainly on shunting left in right in the heart, it is not general surgery that treats indication.

(accept the draft by 1998-09-05)
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