常见先天性心脏病手术时机选择.pptx

常见先天性心脏病的手术时机,韩跃虎,动脉导管未闭,导管大小2mm,应在3-6个月内手术,导管大小2mm,1岁以内有闭合的可能性,1岁以上，根据家属意愿选择手术或介入治疗,房间隔缺损,房缺大小5mm,应在6-8个月内手术,房缺大小5mm,1岁以内有闭合的可能性,1岁以上，根据房缺位置及家属意愿选择手术或介入治疗（92%的继发孔房缺都可采用介入治疗）*,*Experience with transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder: a single centre study in 236 consecutive patients. Heart,室间隔缺损,室缺大小3mm,合并难治性充血性心衰应在3个月内手术*,如心衰等合并症状经药物治疗可缓解，保守观察可延至6个月*,室缺大小3mm,1岁以内有闭合的可能性,1岁以上，合并主动脉瓣脱垂（即使无返流）、心内膜炎病史、心室扩张的患者建议手术治疗*,根据室缺位置及家属意愿选择手术或介入治疗,*Ventricular septal defect. In: Cardiac Surgery, 4th ed.,*Optimal age and results in repair of large ventricular septal defects. J Thorac Cardiocasc Surg.,*How small si too small to close? Ann Thorac Surg.,室间隔缺损,干下型室间隔缺损,易引起主动脉瓣脱垂和主动脉瓣返流，尤其是5岁以后，应早期手术治疗*,右向左分流为主，肺血管阻力8units/m2，肺血管扩张药物治疗无效的患者，没有手术治疗指征,*Ventricular septal defect. In: Pediatric Cardiac Surgery, 3rd ed.,*Surgical management of the conal (supracristal) ventricular septal defect. J Thorac Cardiovasc Surg.,法洛四联症,早期治疗 6-8个月*,避免长期缺氧对神经系统发育的损害 减轻右心室肥厚 减少对肺动脉及肺组织发育的影响,根据患者Macoon比等具体情况选择姑息手术或根治手术,*Early primary repair of tetralogy of Fallot. Semin Thorac Cardiocasc Surg Pediatr Card Surg Annu.,心内膜垫缺损,部分型心内膜垫缺损,完全型心内膜垫缺损,没有二尖瓣/三尖瓣严重返流/左心发育不良的情况下，应在1岁内手术治疗*,常在出生后1-3个月发生充血性心力衰竭，应在3-5个月内行手术治疗。6-9个月还未进行手术的患者易引起不可逆的肺血管阻力上升*,*Primum atrial septal defect in children: early results, risk factors, and freedom from reoperation. Ann Thorac Surg.,*Unique features and prognosis of primum ASD presenting in the first year of life. Circulation.,*Repair of complete atrioventricular canal defects: results with the two-patch technique. Ann Thorac Surg.,单纯动脉导管未闭、房间隔缺损、室间隔缺损 1313例,2015-2017年,3个月1岁内手术