同种带瓣管道治疗复杂先天性心脏病(附31例报告)

The Clinical Application of Homograft Valved Conduit in Complex Congenital Heart Disease

目的研究同种带瓣管道治疗复杂先天性心脏病的疗效。方法1997年12月～2003年4月,我科应用同种带瓣管道治疗复杂先天性心脏病31例。病种包括重症法乐氏四联症(TOF)14例,其中合并动脉导管未闭(PDA)1例,合并肺动脉闭锁(PA)、右肺动脉缺如(RPaA)各1例,PDA+PA1例,右冠状动脉畸形(RCaA)2例;右室双出口(DORV)8例,其中合并RCaA2例;三尖瓣闭锁(TA)1例;大动脉转位(L-TGA)并室间隔缺损(VSD)、肺动脉狭窄(PS)3例;永存动脉干(PTA)2例;主动脉缩窄(CoA)并PDA1例;VSD并PS、RCaA1例;亚急性细菌性心内膜炎(SBE)1例。术式:主、肺动脉单瓣作右室流出道跨瓣补片术14例;Rastelli手术11例;右心室-肺动脉连接(RV-PA)3例;肺动脉瓣置换1例:Ross手术1例;改良Fantan手术1例。结果主、肺动脉单瓣作右室流出道跨瓣补片组14例,1例术后3d死于右心功能不全(7.14%)。存活13例,随访3～57月,超声心动图检查显示移植后瓣膜启闭功能良好,无增厚及粘连。同种带瓣管道移植矫治组17例,死亡7例(41.2%),存活10例,随访9～57月,管道血流通过顺畅,管壁无变薄、钙化。结论同种带瓣管道具有管壁弹性好,易于缝合,术后排斥反应少等优点,可广泛应用于复杂先天性心脏病矫治术、左,右室流出道的重建。同种带瓣管道补片既能加宽右室流出道,且有良好抗反流作用,?

Objective To evaluate the clinical application outcome of cryopreserved homograft in the treatment of congenital heart defects. Methods Homograft bank has been established in our hospital since December 1997. Thirty-one patients with complex congenital heart disease were received cryopreserve valved homograft conduit transplantation(VHC). Their age ranged from 11 months to 3.6 years, with a mean of 6.7±3.2 years and the mean body weight was 17.1± 7.5(9- 55)kg. The cardiac defects were as follows: Tetralogy of Fallot (TOF, 14 cases) among of them,2 cases complicated with patent ductus arteriosus(PDA),one case of pulmonary atresia(PA) and right pulmonary defect(RPaA) in one case,right coronary artery(RCaA) deformity in one case, double outlet right ventricle(DORV)8 cases:2 cases with RCaA deformity,2 cases of tricuspid value stenosis, transposition of the great artery with ventricular septal defect and pulmonary stenosis in 3 cases, onecase of tricuspid valve atresia, one case of coarctation with patent ductus arteriosus, persistent arterious trunks in 2 case, ventricular septal defect(VSD) with right coronary artery abnormal connection in one case, one case of Subauite bacterial endocardctitis(SBE). Monocusoid transannular patch was used in 14 patients. Rastelli operation was performed on 11 patients, right ventricular and pulmonary artery homograft on 3, modified Fontan operation on 1, Ross operation on 1, and pulmonary valve transplantation 1. The regular follow-up procedure has been consisted of physical examination and cardiovascular ultrasonography for three years. Results The Monocusoid transannular patch was used in 14 patients, one of them (7.14%) died of right ventricular failure three days post-operatively. The remaining 13 patients were followed-up for 43±3.2(1～57) months with the grafted valves functional pretty well. VCH were used in 17 cases with complex heart disease. Seven (41.2%) died from various complications. The other 10 cases were alive and followed-up to 30.3±6.39(9～57)months without calcification or degeneration of the graft under echocardiography examination. Conclusions (1) The satisfactory follow-up results of this series suggest that the homograft transplantation may be the first choice to replace the staged operations on complex congenital heart disease correction in children; (2) ROVT reconstruction with cryopreserved monocusoid transannular patch not only wideopen the outflow tract of the right ventricle, but also possesses the ability of anti-regurgitation.