体肺分流.pptVIP

体肺分流适应症和手术技术 体肺分流手术的目的 增加氧饱和度，缓解紫绀增加肺动脉的尺寸肺动脉闭锁单一化手术的准备心室锻炼的附加手术促进心室发育 单心室矫治的过渡手术 体肺分流——适应症 肺血流不足合并紫绀 四联症 3个月以下的四联症？ Kolcz J, Pizarro C.?Neonatal repair of tetralogy of Fallot results in improved pulmonary artery development without increased need for reintervention.?Eur J Cardiothorac Surg.?Sep?2005;28(3):394-9. Hirsch JC, Mosca RS, Bove EL.?Complete repair of tetralogy of Fallot in the neonate: results in the modern era.?Ann Surg.?Oct?2000;232(4):508-14.? Pigula FA, Khalil PN, Mayer JE, et al.?Repair of tetralogy of Fallot in neonates and young infants.?Circulation.?Nov 9?1999;100(19 Suppl):II157-61. Parry AJ, McElhinney DB, Kung GC, et al.?Elective primary repair of acyanotic tetralogy of Fallot in early infancy: overall outcome and impact on the pulmonary valve.?J Am Coll Cardiol.?Dec?2000;36(7):2279-83.? Fraser CD, McKenzie D, Cooley DA. Tetralogy of Fallot: Surgical management individualized to the patient. Ann Thorac Surg. 2001;71:1556-63. van Arsdell GS, Maharaj GS, Tom J, et al. What is the optimal age for repair of tetralogy of Fallot?. Circulation. Nov 7 2000;102(19 Suppl 3):III123-9 冠脉异常 Fellows KE, Freed MD, Keane JF, et al.?Results of routine preoperative coronary angiography in tetralogy of Fallot.?Circulation.?Mar?1975;51(3):561-6.?. Hurwitz RA, Smith W, King H, et al.?Tetralogy of Fallot with abnormal coronary artery: 1967 to 1977.?J Thorac Cardiovasc Surg.?Jul?1980;80(1):129-34.? Need LR, Powell AJ, del Nido P, Geva T.?Coronary echocardiography in tetralogy of fallot: diagnostic accuracy, resource utilization and surgical implications over 13 years.?J Am Coll Cardiol.?Oct?2000;36(4):1371-7. 肺动脉发育差不够根治条件 1岁以内的单侧肺动脉缺如 合并其他复杂畸形 肺动脉闭锁？ 室间隔完整合并冠脉依赖型的PA－单心室矫治 左右肺动脉发育差的PA＋VSD－为肺动脉融合做准备 三尖瓣闭锁合并PS Fontan手术的准备 单心室合并PS Glenn或全腔的准备手术 大动脉转位合并VSD和PS，年龄小，发育差 新生儿Ebstein畸形 理想的分流 容易操作，快速 能够提供足够但不是过多的肺动脉血流，不易发生减低心衰和肺高压的风险 能够长期保持通畅 再次手术时，技术上容易闭合 闭合后，无残留畸形或异常 体肺分流——类型 历史 经典BT----锁骨下动脉到肺动脉 Waterson——主动脉到右肺动脉 Pott’s——降主动脉到左肺动脉 当前 改良BT——Goretex从锁骨下到肺动脉 中