Konno术在小儿左心室流出道梗阻中的临床应用

摘要

目的 总结Konno手术治疗小儿左心室流出道梗阻(LVOTO)的近、中期效果.方法 2006年5月至2012年5月共收治16例LVOTO患儿,年龄1.9～13.6岁,平均(5.1±0.7)岁；体质量12 ～39 kg,平均(18.3±6.3) kg.其中13例(81.3％)有两个以上部位的LVOTO.超声评估LVOTO压差56 ～ 185mmHg(1mmHg =0.133 kPa),平均(96±31) mmHg.手术在中低温(28C ～ 30℃)体外循环下进行,体外循环70 ～182min,平均(98±21) min；主动脉阻断34 ～148min,平均(51±11) min.单纯Konno手术3例；Konno± Ross手术4例；Konno-Rastan(主动脉瓣置换)手术9例.结果 患儿术后无死亡.呼吸机辅助3～9天,平均(4.0±1.5)天.住ICU5～16天,平均(8.0±2.9)天.术后随访6个月～3年.心脏超声检查无明显残余梗阻,LVOTO流速1.10 ～2.42 m/s；左心室射血分数0.58 ～0.72,平均0.66±0.03.主动脉瓣反流轻到中度2例,中-重度1例,余均为轻度；1例出现肺动脉瓣中度反流,三尖瓣轻到中度反流.结论 Konno手术治疗小儿LVOTO安全、有效,利于患儿左心功能恢复,远期并发症情况尚需进一步随访.%Objective Reviewed and evulated the prognosis of multiple levels of left ventricular outflow tract obstruction (LVOTO) with Konno operation.Methods Between May 2006 and May 2012,we performed Konno operation in 16 children with LVOTO.They aged from 1.9 to 13.6 years,averaged(5.1 ± 0.7)years,and weighted from 12 to 39 kg,averaged (18.3 ±6.3) kg.There are 13 cases of patients who were multiple levels of LVOTO.The pressure gradient of LVOTO was 56-185 mmHg[(96 ± 31) mm Hg].The operations were performed with middle low temperature in cardiopulmonary bypass (CPB).The time for CPB and Aortic clamp arrest was 70-182 min [(98 ± 21) min] and 34-148 min[(51 ± 11) min] respectively.There were 3 cases,4 cases and 9 cases for Konno,Konno ± Ross and Konno-Rastan respectively.Results All the pacients were alive.The time for making use of respirometer and staying in ICU was 3-9 days [(4.0 ± 1.5) days] and 5-16 days [(8.0 ±2.9) days] respectively.Follow-up with 6 months to 3 years,the ECHO showed no residual obstruction.The pressure gradient of LVOTO was 1.10-2.42 m/s.LVEF was 0.58-0.72 (0.66 ± 0.03).There were 2 cases for mild to middle aortic valve regurgitation,1 case for middle to severe aortic valve regurgitation and 1 case for middle pulmonary valve regurgitation and middle tricuspid valve regurgitation.Conclusion Konno procedure is safty and effective operation for LVOTO in children and is beneficial to the recovery of left ventricular function.It is necessary to follow up the complication in the future.