肺动脉闭锁伴室间隔缺损的分期手术治疗课件

肺动脉闭锁伴室间隔缺损的 分期手术治疗 zzq What is PA/VSD? nCastaneda AR. Cardiac surgery of the neonate and infant. Philadelphia:WB Saunders Co, 1994:21534. nMair DD. Heart disease in infants, children, and adolescents,including the fetus and young adult, vol II. Baltimore:Williams 44:1424. Single stage unifocalization nReddy VM（1995）：10例 nReddy VM（2000）：85例 nHanley FL（2005）：307例 nMalhotra SP（2009）：462例 Large Caliber MAPCAs Without Significant Segmental Level Stenoses (56%) Small-To-Moderate Caliber MAPCAs Without Segmental Level Stenoses (20%) MAPCAs With Extensive Segmental Level Stenoses (12%) Centrally Confluent Fully Arborizing Hypoplastic True Pulmonary Arteries With “Dual Supply” MAPCAs (12%) Single stage unifocalization n特别重视MAPCAs的形态：大小/狭窄 n自身肺动脉（NPA）对单源化和手术结果的影响 The median diameter of true PAs was 2.0 mm. Complete absence of intrapericardial pulmonary arteries occurred in 23.5% of patients. “complete absence of true pulmonary arteries” had no adverse influence on early outcome. Griselli M, McGuirk SP, Winlaw DS, et al. J Thorac Cardiovasc Surg 2004;127:513. nThis series included 164 patients over an 11-year period. A 69% complete repair was achieved. nthe best prognosis was with intrapericardial pulmonary arteries that were at least 75% of predicted size. nThe worst prognosis was in patients with no native pulmonary arteries, and the entire pulmonary blood supply supplied by collaterals only. There were no survivors at 10 years in this patient subgroup. nPatients with diminutive but present native pulmonary arteries had an intermediate survival. dUdekem Y, Alphonso N, Martin A, et al. J Thorac Cardiovasc Surg 2005;130:1496 502. nA series of 82 consecutive patients between 1975 and 1995 nlate survival depended exclusively on the growth of the native pulmonary circulation. nThe few unifocalized MAPCAs that did not thrombose failed to grow and did nothing to increase pulmonary vasculature. nan initial goal should aim at achieving growth of the native pulmonary art