肺动脉束带术的临床经验

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 operationInitially 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 single 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: 33.78monthBody 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 Physiological Single Ventricle,Surgical Management,Staged operation：First Stage: PABSecond Stage: Bidirectional GlennSimultaneous Operation：Glenn+PAB,(1) Staged Operation,Patients Characteristics,13 casesAge: 3-60 months mean 23.46 monthsBW: 4-16kg mean 9.23kgSaO2 : 86.28.1%,Patients Characteristics,SV 7 casesTA 3 casesDORV functional SV 2 casesMA 1 case,Intraoperative Data,Before PAB PAP: 38.8210.04 mmHg SaO2 :86%20.8%After PAB PAP: 25.926.65 mmHg SaO2 :80.27% 7.7%,Results,PAP decrease satisfactorily : 8 cases Second stage Glenn: 2 casesSecond stage Bjork: 1 casesThird stage TCPC: 1 caseOperation 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,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 70.511mmHg,UCG)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 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 death 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 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 1 case,Intraoperative Data,Before PABAoP: 53.725.44 mmHgPAP: 39.87.43 mmHgAfter PABAoP: 58.84 6.7 mmHgPAP: 27.110.24 mmHg,Results,PAP decreased satisfactorily: 3 cases and underwent 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 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 VSDPoor l