双向腔静脉肺动脉吻合术辅助治疗右心发育不良双心室解剖矫治术的实验研究

Experimental Study on Biventricular Repair of Hypoplastic Right Ventricle Assisted by Bidirectional Cavopulmonary Anastomosis

目的：在双向腔静脉肺动脉吻合术辅助下，完成双心室解剖矫治术的右心室容积最低限度值，观察血流动力学特点，为右心室发育不良的先天性心脏病双心室矫治术，提供理论基础及实验数据。方法：游离右上腔静脉，奇静脉结扎、切断；近右心房部位横行切断右上腔静脉，其远心端与右肺动脉端侧吻合，近心端缝闭，建立犬的双向腔静脉肺动脉吻合术的模型（ｎ＝１７）；采用介入性治疗二尖瓣狭窄的球囊导管（容积３０ｍｌ）作为材料，将球囊放置实验犬的右心室的心尖部，通过球囊体积的改变，形成右心室容积大小改变，建立右心室容积发育不良动物实验模型。结果：双向腔静脉肺动脉吻合术建立之后，右心室容积为正常的２５％以下时，主要血流动力学指标出现明显改变，如：血压、心率、心输出量等。结论：如果右心室容积是正常的２５％以上，则可以在双向腔静脉肺动脉吻合术辅助下完成双心室解剖矫治术。

Objective:To get minimal volume of the right ventricle during biventricular repair assisted by bidirectional cavopulmonary anastomosis without side effects on the hemodynamics. Methods:Under cardiopulmonary bypass,complete division of the superior vena cava,right pulmonary artery,and azygous vein was performed.The azygous vein was ligated.The right superior vena cava at the level of the right pulmonary artery was transected,its distal end was anastomosed to the upper side of right pulmonary artery and its proximal end was sutured,bidirectional cavopulmonary anastomasis was thus established in dogs ( n =17).Inoue balloon catheter for interventional treatment of mitral valve stenosis was applied to the apex of right ventricle to set up different stages of hypoplastic right ventricular models. Results:After establishment of bidirectional cavopulmonary anastomosis,as the right ventricular volume was below 25% of normal,the hemodynamics such as blood pressure,heart rate and cardiac output changed markedly. Conclusion:Biventricular repair assisted by bidirectional cavopulmonary anastomosis could be performed as the volume of the right ventricle is above 25% of normal.