Surgical Treatment Of Pulmonary Atresia With Ventricular Spetal Defect

Objective:To explore the surgical strategy of pulmonary atresia with ventricular septal defect (PA/VSD). The clinical data of a series of36cases with PA/VSD who accepted surgical treatment in our department recent years are analysed.Methods:From Mar.2007to Apr.2012,36patients with PA/VSD consecutive underwent surgical treatment in the department of paediatric heart surgery of Second XiangYa Hospital.All the patient had clear diagnoses and. were indicated to surgery. They consist of10of type A,21of type B and5of type C,15cases underwent palliative operation,and corrective surgery were performed in2cases of cental shunt finally,23cases accepted radical operation,5cases were treated with the patch of decellularized and photo-oxidation acellular bovine jugular vein condui (BJVC),17cases were treated with the BJVC.The different clinical types and surgical:procedures were compared with each other in preoperative information、postoperative early and mid-term outcome, analyzing the risk factors for surgery and evaluating the early efficacy of Surgical treatment. Follow-up information after discharge were analyzed and to assess the effects, especially about application of BJVC. Apply SPSS19.0statistical software for statistical analysis.Results:.Three types are analyzed using statistical techniques and methods,there are significantly different (p<0.05) with age、height、 weight、SpO2、McGoon values and no statistical difference with radical rate. The radical cases can be divided into2group by types of procedure,patch and conduit.There was no statistical difference among two groups about the clinical parameters, except CPB time (P<0.05) Analysis of risk factors related to mortality indicated age、CPB time and RV/LV ratio. RV/LV ratio is relatively strong risk factors. There are5peroperative deaths,and the general mortality arrives at13.9%.31cases were followed up in2-59months,Apr2012, The average follow-up time was31±1.7.6months. During the follow-up there was3.deaths and the cases that accepted radical operation successfully no dead. The New York Association functional class of the patients that accepted radical operation successfully go between Ⅰ～Ⅱ level.22cases underwent radical operation using decellularized and photo-oxidation acellular bovine jugular vein condui (BJVC) or patch.Echocardiography showed that the level of pulmonic regurgitation was low and pulmonary valve fuction was good.Conclusion:1. PA/VSD is complex lesion, with the highly mortality rate.2. A successful regimen must be tailored to account for the complexity and variability of this lesion.3. Decellularized and photo-oxidation acellular bovine jugular vein conduit (BJVC) as a alternaive materials of pulmonary artery showed a good early and medium-term results.