常见先天性心脏病手术时机选择.pptx

单击此处编辑母版标题样式,编辑母版文本样式,第二级,第三级,第四级,第五级,2018/1/7,#,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,5mm,应在,6-8,个月,内手术,房缺大小,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,8units/m,2,，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,3,rd,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,612,例,1,岁以上手术,593,例,死亡率无统计学差异（,P2mm 3-6,个月手术,5mm 6-8,个月手术,3mm 3-6,个月手术,3mm 1,岁后手术或介入治疗,法洛四联症,早期手术,6-8,个月,心内膜垫缺损,部分型,1,岁内手术,完全型,3-9,个月内手术,6,个月左右,谢谢,