Gore-Tex片作单瓣重建右心室流出道的早、中期疗效

Outcome of Short and Middle Term of Right Ventricular Outlet Tract Reconstruction with Gore-Tex Monocusp Valve

目的 评价0．1mm厚的Gore—Tex片作肺动脉单瓣重建右心室流出道（RVOT）的早中期l临床效果。方法 2002年6月至2006年7月，对48例合并肺动脉狭窄或闭锁的先天性心脏病患者施行矫治手术，术中采用0．1mm厚的Gore—Tex片作肺动脉单瓣的Dacron血管片重建RVOT，其中包括法洛四联症合并肺动脉狭窄33例、Ⅰ型肺动脉闭锁8例、肺动脉瓣缺如3例，右心室双出口合并肺动脉狭窄2例，永存动脉干1例，完全型大动脉错位、室间隔缺损、肺动脉狭窄1例。结果 本组无手术死亡。术后血氧饱和度达1．00，右心室／左心室收缩压比值0．22～0．65，右心室与左、右肺动脉压差〈10mmHg。所有患者（100％）均随访3～48个月，无死亡和并发症。彩色多普勒超声心动图检查提示：无肺动脉狭窄，肺动脉瓣轻度反流13例，中度反流5例，Gore—Tex膜具有活动功能40例。结论 采用0．1mm厚的Gore—Tex片作单瓣重建RVOT，其早中期临床结果显示有较满意的血流动力学效果。

Objective To evaluate the outcome of reconstruction of right ventricular outlet tract （RVOT） with 0. 1 mm Gore-Tex monocusp valve for short and middle term. Methods Between June 2002 to July 2006, 48 patients underwent reconstruction of RVOT with Gore-Tex monocusp valve to correct cardiac anomalies, including 33 patients with tetralogy of Fallot （TOF） and pulmonary stenosis, 8 patients with TOF and pulmonary atresia, 3 patients with TOF and absent pulmonary valve, 2 patients with double outlet of right ventricle and pulmonary stenosis, 1 patient with truncus arterious and 1 patient with complete transposition of great artery, ventricular septal defect and pulmonary stenosis. Results There was no operative death. The postoperative blood oxygen saturation was up to 1.00. The ratioes of right ventricular systolic pressure and left ventricular systolic pressure were between 0.22 to 0. 65. The gradient between right ventricle and left or right pulmonary artery was less than 10 mmHg. All patients were followed up including echocardiography ranged from 3 to 48 months. There were no late death and complication, Trivial and mild pulmonary insufficiency was detected in 18 patients and valvular motion remained competent in 40 patients. Conclusion The results suggest that the reconstruction of RVOT with Gore-Tex monoeusp valve can achieve excellent outcome for short and middle term.