肺动脉束带术的临床经验_培训课件.pptVIP

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肺动脉束带术的临床经验_培训课件.ppt

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Fu Wai Cardiovascular Disease Hospital Pediatric Surgical Center ShouJun Li History 1952 Muller and Dammann firstly introduced the PAB operation Initially for treatment of congenital anomalies with pulmonary hypertension Primary repair has replaced PAB in treatment for PH Current Indications of PAB in Advanced Countries Staged palliation for physiological single ventricle with unobstructed pulmonary flow 3-4 weeks Two-stage arterial switch operation Beyond the neonatal period Clinical Data 1997-2003 Total: 32 cases Male 19, Female 13 Age: 2 months - 24 years, mean: 33.78month Body weight (BW): 3.25-41kg, mean: 10.7kg Indications Physiological single ventricle Other anomalies with unrestricted pulmonary flow Beyond the neonatal period TGA : left ventricular training Treatment of Physiological Single Ventricle Surgical Management Staged operation： First Stage: PAB Second Stage: Bidirectional Glenn Simultaneous Operation：Glenn+PAB (1) Staged Operation Patients’ Characteristics 13 cases Age: 3-60 months mean 23.46 months BW: 4-16kg mean 9.23kg SaO2 : 86.2±8.1% Patients’ Characteristics SV 7 cases TA 3 cases DORV functional SV 2 cases MA 1 case Intraoperative Data Before PAB PAP: 38.82±10.04 mmHg SaO2 :86%±20.8% After PAB PAP: 25.92±6.65 mmHg SaO2 :80.27% ±7.7% Results PAP decrease satisfactorily : 8 cases Second stage Glenn: 2 cases Second stage Bjork: 1 cases Third stage TCPC: 1 case Operation interval: 1-2 years Waiting for further stage treatment : 4 cases Results PAP decrease unsatisfactorily: 5 cases Redo PAB: 1 case Third-time PAB: 1 case Untreated: 3 cases (2) Simultaneous PAB + Glenn Patients’ Characteristics 6 cases Age: 1-24 years BW: 8-41kg ,mean 21.5kg SaO2 : 73 ± 7.0% Patients’ Characteristics DORV + PS: 3 cases SV + PS: 1 case ECD + C-TGA + PS: 1 case (PAP gradient 70.5±11mmHg,UCG) TA 1 case (PA=35/20(30)mmHg catheterization) Intraoperative Data Before PAB PAP: 19.33 ± 4.53 mm