肺動脈束帶術(shù)的臨床經(jīng)驗

1、Indications of pulmonary artery banding (PAB) in congenital cardiac surgery,Fu Wai Cardiovascular Disease HospitalPediatric Surgical CenterShouJun Li,History,1952 Muller and Dammann firstly introduced the PAB operati

2、onInitially for treatment of congenital anomalies with pulmonary hypertensionPrimary repair has replaced PAB in treatment for PH,Current Indications of PAB in Advanced Countries,Staged palliation for physiological sing

3、le ventricle with unobstructed pulmonary flow3-4 weeksTwo-stage arterial switch operationBeyond the neonatal period,Clinical Data,1997-2003Total: 32 cases Male 19, Female 13Age: 2 months - 24 years, mean: 33.78mo

4、nthBody weight (BW): 3.25-41kg, mean: 10.7kg,Indications,Physiological single ventricleOther anomalies with unrestricted pulmonary flowBeyond the neonatal period TGA : left ventricular training,Treatment of Physiol

5、ogical Single Ventricle,,Surgical Management,Staged operation：First Stage: PABSecond Stage: Bidirectional GlennSimultaneous Operation：Glenn+PAB,(1) Staged Operation,,Patients’ Characteristics,13 casesAge: 3-60 month

6、s mean 23.46 monthsBW: 4-16kg mean 9.23kgSaO2 : 86.2±8.1%,Patients’ Characteristics,SV 7 casesTA 3 casesDORV functional SV 2 casesMA 1 case,Intraoperative Data,Before PAB PAP: 38.82±10.04 mmHg

7、 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 casesSecond stage Bjork: 1 casesThird stage TCPC: 1 case

8、Operation interval: 1-2 years Waiting for further stage treatment : 4 cases,Results,PAP decrease unsatisfactorily: 5 casesRedo PAB: 1 caseThird-time PAB: 1 case Untreated: 3 cases,(2) Simultaneous PAB + Glenn,

9、,Patients’ Characteristics,6 casesAge: 1-24 yearsBW: 8-41kg ,mean 21.5kgSaO2 : 73 ± 7.0%,Patients’ Characteristics,DORV + PS: 3 casesSV + PS: 1 caseECD + C-TGA + PS: 1 case (PAP gradient 70.5±11mmHg,UC

10、G)TA 1 case (PA=35/20(30)mmHg catheterization),Intraoperative Data,Before PAB PAP: 19.33 ± 4.53 mmHSaO2:89% ± 6.0%After PABPAP: 15.50 ± 4.0 mmHgSaO2:87.3% ± 5%,Results,All these 6 patients

11、recovered uneventfully and without major complication,Discussion,PAP >19mmHg PAB + Glenn simultaneously Postoperative PAP 15mmHgModerate PH（PAP 38mmHg） Staged PAB followed by Glenn or FontanNo de

12、ath and major complication in this cohort SV patients,Other Anomalies with Unrestricted Pulmonary Flow,,Objective,Restrict pulmonary flowDelay the development of PHSeek the possibility for further treatment,Patients’

13、 Data,10 casesAge: 3-66 months, mean 15.27 monthBW: 5-16kg, mean 7.54kg,Patients’ Characteristics,DORV+PH 6 casesECD+PH 1 caseTruncus Arteriosus 1 caseECD+Truncus 1 caseVSD+PH

14、 1 case,Intraoperative Data,Before PABAoP: 53.72±5.44 mmHgPAP: 39.8±7.43 mmHgAfter PABAoP: 58.84 ±6.7 mmHgPAP: 27.1±10.24 mmHg,Results,PAP decreased satisfactorily: 3 cases and under

15、went further repair operation PAP decreased unsatisfactorily: 5 cases Death: 2 cases truncus arteriosus,Discussion,Patients with severe PHPAB could partly benefit the patients and lower the PAP, provide the chance

16、for further surgical treatmentSecond-stage repair operation ?Heart lung transplantation,Beyond the neonatal period TGA (left ventricular training),,Patients’ Characteristics,5 cases Age: 2-16 monthsTGA without VSDP