- 期刊
Surgical Closure of Apical Muscular Ventricular Septal Defects via a Right Ventriculotomy
經由右心室以手術方式關閉頂端部肌肉型心室中隔缺損
摘要
以藥物或者是手術的方式治療多肌肉型心室中隔缺損在臨床上仍是有高的致病率以及死亡率。在手術過程中，經由右心房要去確認，進而以手術方式關閉位於遠在右心室肌肉群之後的肌肉型心室中隔缺損，在臨床上有很大的困難。不過，經由在右心室尖頂端部的一個小切口，去直接探視頂端部肌肉型的心室中隔缺損，在我們的經驗中，是非常容易的，而且可以很明確的看清楚缺損的範圍。 在2004年5月，有2位先天性心臓病病人併有頂端部肌肉型心室中隔缺損，此缺捐位於左心室肌肉心室中隔的頂端以及右心室的漏斗部之間。病人甲是一位9個月大女生，其心臓缺損為乳酪型心室中隔缺損併有頂端肌肉型心室中隔缺損，而病人乙則是一位18天大的男嬰，其缺損為多重肌肉心室中隔缺損（含動脈下心室中隔缺損以及頂端部的肌肉型心室中隔缺損）及主動脈弓縮窄。 我們藉由經右心室尖頂端部切開的方式進行頂端部的肌肉型心室中隔缺損的修補。此二位病人，由同樣的方式完成手術，而完全的矯正了心臓的結構異常。在術後心臓超音波追蹤下，僅剩餘微不足道的心室中隔缺損血流，而且仍具有良好的左右心室收縮功能。在手術後第5個月的心臓超音波追蹤發現，之前剩餘心室中隔缺損已完全消失，而且沒有任何併發症。藉由這二個成功的例子，可以提供一些經驗，即使在嬰兒期，藉由右心室尖頂端部的一個小視野，進行頂端部肌肉型的心室中隔缺損補修是一個安全，成功率高而且比較少後遺症的手術方式。
並列摘要
Identification and surgical closure of apical muscular ventricular septal defects are associated with certain morbidity and mortality because of their location in the ventricular septum distal to the moderator band, making adequate visualization and complete closure from the right atrium almost impossible. However, the precise margins of apical VSDs can be readily identified by a small apical right ventriculotomy. We report two infant patients with congenital heart disease and apical muscular VSDs communicating between the left ventricular apex and the RV infundibular apex. Patient A was a 9-month old female who had a swiss-cheese type VSD (apical VSDs below the moderator band and one VSD at the high infundibular portion). Patient B was a 18-day old male who had coaractation of the aorta (CoA), patent ductus arteriosus (PDA), and multiple VSDs (subarterial doubly committed type VSD with apical muscular type VSDs). Their apical VSDs were closed with separate patches via apical right ventriculotomy. The associated cardiac defects were all corrected during the single operation. Good biventricular contractility without residual VSD were confirmed by 14-month follow-up. The successful outcome of these two patients indicates that surgical closure of apical muscular VSDs can be achieved safely and completely in early in early infancy through a limited apical right ventriculotomy.
延伸閱讀
- Lee, S. T., Lin, T. H., Su, H. M., Chiu, C. C., Voon, W. C., Lai, W. T., Sheu, S. H., & Lin, Y. T. (2005). 無伴隨心室中隔缺損的主動脈竇動脈瘤破裂到右心房：病例報告及文獻回顧. The Kaohsiung Journal of Medical Sciences, 21(12), 517-521. https://www.airitilibrary.com/Article/Detail?DocID=02575655-200512-21-12-517-521-a
- 黃意然（2019）。探討使用心導管關閉繼發孔型心房中膈缺損之關閉器尺寸過大的偏差〔碩士論文，中山醫學大學〕。華藝線上圖書館。https://doi.org/10.6834/CSMU201900150
- Lin, M. C., Fu, Y. C., Jan, S. L., Ho, C. L., Chi, C. S., & Hwang, B. (2007). 經心導管使用安普拉茲封堵器關閉大型存開性動脈導管. Acta Cardiologica Sinica, 23(2), 103-108. https://www.airitilibrary.com/Article/Detail?DocID=10116842-200706-23-2-103-108-a
- Chi, M. H., Chen, M. R., Hwang, H. K., & Lin, Y. C. (2007). 經皮心導管螺旋線圈栓塞術治療一個巨大的右冠狀動脈至右心室動脈瘻管. Acta Cardiologica Sinica, 23(1), 43-49. https://www.airitilibrary.com/Article/Detail?DocID=10116842-200703-23-1-43-49-a
- Yang, T. H., Lu, C. W., Jean, W. H., & Lin, T. Y. (2019). 二尖瓣置換術後之醫源性急性主動脈瓣閉鎖不全. 輔仁醫學期刊, 17(1), 23-27. https://doi.org/10.3966/181020932019031701003