自体心包同时扩大肺动脉瓣环与瓣膜技术重建右室流出道的临床研究

The clinical results of right ventricular outflow tract reconstruction with a transannular patch of autologous pericardium

目的探讨自体心包同时扩大肺动脉瓣环与瓣膜的跨环补片技术在右心室流出道(RVOT)重建术中的应用价值。方法采用心包片扩大原有的瓣叶、瓣环或重建新的瓣叶2种技术,对32例先天性心脏病病人行 RVOT 重建手术。包括法洛四联症24例,右心室双出口法四型5例,重度肺动脉狭窄3例。结果本组手术死亡1例,术后其他并发症6例治愈。31例随访4～40个月,心功能Ⅰ～Ⅱ级,肺动脉瓣功能良好;无或微量肺动脉瓣返流17例、轻度12例、中度2例。无需再次手术病人。结论自体心包同时扩大肺动脉瓣环与瓣膜技术重建 RVOT 的近、中期效果良好,远期效果有待于观察。

Objective To evaluate the application value of simultaneous enlargement of the pulmonary annulus and the pulmonary cusp with a transannular patch of autologous pericardium in right ventricular outflow tract（ RVOT） reconstruction. Methods Thirty-two patients who had complex congenital heart diseases received the technique between Jan. 2003 and Dec. 2005. Two surgical approaches were developed to construct a competent neocusp with autologous pericardium that could be extended through the pulmonary valve annulus or valve commissures. Results There was only 1 early death. The postoperative complications occurred in 6 patients recovered uneventfully. The results of the 4 - 40 month follow-up in 31 patients showed good motion of reconstructed cusps. 17 patients had no or trivial pulmonary insufficiency. There was mild insufficiency in 12 patients and moderate insufficiency in 2. None of these patients needed reoperatious. Conclusion The surgical technique of simultaneous enlargement of the pulmonary annulus and the pulmonary cusp with a transannular patch of autologous pericardium is a safe, reliable and effective way for RVOT reconstruction. However, further close follow-up is needed to determine the true value of this technique.