DIAGNOSIS AND SURGICAL TREATMENT OF AORTOPULMONARY SEPTAL DEFECT
Yu JG, Zhang ZW, Zhu XK, et al.
Affiliated Children's
Hospital, Medical College of Zhejiang University, Hangzhou, China
Objective: To
study the diagnosis and surgical treatment of aortopulmonary septal defect (APSD).
Clinic and Method: From May 1986 to June 2000,8
patients with APSD underwent operation with a mean age 2.7±1.0 year and a mean body weight 10.8±1.5KG. Cardiac
catheterization in 6 patients showed a large left-to-right shunt (mean
pulmonary/systemic flow ratio, 3.64±0.82)
with severe pulmonary artery hypertension (mean pulmonary/systemic pressure
ratio, 0.88±0.04)and
increased pulmonary vascular resistance (mean value 6.86±2.08 Woods).Associated anomalies were patent
ductus arteriosus (PDA) in 1 and type A interrupted aortic arch (IAA) in 2.
Cardiopulmonary bypass and moderate hypothermia were used in all 8
patients. The APSD was divided and oversewn in 1.In 7 patients, the defect
was closed with a patch using various approaches: transaortic in 2, transpulmonary
in 2 and trans-window in 3. The patch material consisted of Gore-Tex in 2
and native pericardium in 5. Associated anomalies were repaired
simultaneously.
Result: Three of eight APSDs were
misdiagnosed.All patients had a severe pulmonary hypertension before
operation. There was a pulmonary hypertension crisis in 3, heart failure in
1 and chylothorax in 1 after operation .One patient associated with IAA
died after operation due to pulmonary hypertension crisis and heart failure.
Conclusion: Correct
preoperative diagnosis, satisfactory surgical treatment and active
treatment of postoperative pulmonary hypertension are key to gain good
outcomes.