什么时候手术修复先天性心脏缺陷是可取的?
先天性心脏缺陷的修复是如何完成的?
这种手术的风险和好处是什么?
典型的复苏包括什么?
什么时候手术修复先天性心脏缺陷是可取的?
有许多不同种类的 先天性心脏缺陷也就是说，自出生以来心脏结构就存在异常. 它们在频率和复杂程度上差别很大, 以及症状首次出现的时间和症状的严重程度.
非常严重的先天性心脏缺陷必须在婴儿期治疗, but some defects don't become a problem until many years later; or sometimes, 婴儿期的修复需要在成年期重新修复. We offer adult re-repair of congenital defects that were operated on in infancy or childhood, as well as repair of congenital defects that don't become evident until adulthood.
Your surgeon will evaluate the specifics of your situation and help you weigh the risks of surgery against the risks of managing the disorder with medication and other nonsurgical treatments. The advisability of surgical repair is highly variable and dependent entirely on the circumstances of each individual situation. However, an untreated congenital defect that has begun to cause symptoms may often lead to 充血性心力衰竭.
你和你的外科医生应该决定手术的时机吗, keep in mind that we offer exceptional expertise in the surgical repair of 先天性心脏缺陷, as one of the surgeons on the team is fully trained in the repair of adult 先天性心脏缺陷 and has more than 20 years of experience in performing such repairs.
先天性心脏缺陷的修复是如何完成的?
修复的方法几乎一样多 先天性心脏缺陷 因为有这样的缺陷. 在某些情况下, 然而, the repair or re-repair in adulthood of a congenital defect is similar to the repair of acquired diseases on the same part of the heart. Your surgeon will be able to explain in detail the exact process by which your repair will be accomplished.
先天性心脏缺陷通常通过开放式手术修复. 在某些情况下, 然而, such procedures can be accomplished using minimally invasive techniques. 合适的方法取决于许多因素, 从你的缺陷细节到你的整体健康状况. These are the primary options; your surgeon will determine which one is best in your particular situation:
- 开胸手术 需要在胸骨中间做一个7到10英寸的切口, 或胸骨, 然后分开胸骨，进入心脏. 在某些情况下 a less invasive option, involving a slightly smaller sternal incision, is possible. 然后对先天缺陷进行修复或再修复.
在手术过程中有必要让你的心脏停止跳动, so the operation can be performed on a motionless and bloodless field; while your heart is stopped, a device known as a heart-lung bypass machine will take over your heart's function and maintain your circulation. 偶尔, 在涉及主动脉的复杂手术中, you may also be put into a state known as hypothermic circulatory arrest; this involves lowering your body temperature to significantly slow your body's cellular activity, 让你的血液流动暂时停止. (“体温过低”一词来自希腊语，意思是“低热量”,而“循环停止”的意思是你的血液循环停止了, 或停止.)在其他情况下, a technique known as axillary cannulation (or the insertion of a drainage tube, 被称为套管, 在你腋窝的动脉里, or axilla) can allow aortic replacement to be performed without hypothermic circulatory arrest; this advance may reduce the incidence of postoperative strokes and neurological deficits.
- 微创手术 involves making one or two much smaller incisions (typically 2 to 4 inches) in the side of your chest, 在你的肋骨之间. 然后通过插入x射线相机和长, 薄的手术器械到先天性缺陷的位置. 微创手术 also requires the use of a heart-lung bypass machine. 在适当的情况下, 这种方法避免了劈开胸骨和打开整个胸部的需要, 因此，复苏可能会更快.
这种手术的风险和好处是什么?
It is important to keep in mind that every medical choice involves a trade-off between risks and benefits—whether it is to undergo surgery, 服药, or even just carefully monitor a condition (an option known as "watchful waiting").
在修复或再修复先天性心脏缺陷的情况下, deciding whether surgery is advisable involves balancing the risks involved in any heart surgery against the risk that managing the disorder with medication and other nonsurgical treatments may result in progressive damage to your heart and circulatory system.
The risks involved in surgery are typically fairly low; your surgeon will be able to explain the likelihood of complications given the particulars of your situation, 包括你的年龄和整体健康状况. In general, 然而, the risk of mortality, or death, from cardiac surgery is quite low. 心 surgery is also associated with a small risk of a blood clot that causes a serious stroke. And any surgical procedure involves a very small risk of other complications, such as infection.
病人 who smoke can reduce their risk of complications if they stop smoking at least 2 to 4 weeks before their surgery (it is best not to quit immediately before having heart surgery, 然而, 因为当人们戒烟时，他们经常会有短期的支气管漏, 或者是呼吸道分泌物过多, which makes them cough a lot—and coughing a lot when you have just had heart surgery is not a good idea).
The benefits of successful surgery are usually considerable; your surgeon will be able to explain the likely outcome in your case.
典型的复苏包括什么?
一个典型的心脏直视手术需要4到6个小时, in some cases up to 8 hours; patients are then maintained under general anesthesia for an additional 4 to 6 hours. 如果他们的心脏运转良好，没有过多的出血, 他们可以从麻醉中恢复过来，并拔掉呼吸管. Most patients stay in the ICU until midday of the day after their procedure; if they continue to do well, the drainage tubes in their chest can then be removed and they can be moved to a regular hospital bed later that day.
典型的住院时间为4至7天. 在这一点上, 绝大多数病人都能回家, 在探访护士服务的支持下, though about 15% to 20% may need to spend some time in a rehab facility for more extensive rehabilitation. 出院后, patients are advised not to drive for about three weeks and not to lift anything heavier than 5 pounds for about 6 weeks. 超过这个点，他们可以恢复他们想要的任何活动.
病人往往会惊讶于控制疼痛是多么容易. 手术后的第二天, 大多数病人不用静脉注射止痛药物就会感到舒服, 只服用口服止痛药, 绝大多数人出院后只服用泰诺或布林.
在需要微创手术的情况下, both the length of the operation and the recovery period are typically shorter.
审查页面:2018年6月26日
编辑:Jock McCullough, MD