液氮深低温保存同种带瓣管道移植治疗复杂先天性心脏病17例

Cryopreserved valved homograft conduit for the treatment of complex congenital heart disease in 17 cases

目的:同种带瓣管道已经广泛应用于复杂先天性心脏病的治疗,临床应用中显示了良好的近中期效果,但其长期耐久性还有待提高。回顾性分析自行制备和液氮深低温保存的同种带瓣管道治疗复杂先天性心脏病的临床应用效果。方法:①选择南京大学医学院附属鼓楼医院心胸外科2003-01/2007-10应用同种带瓣管道治疗复杂先天性心脏病的患者17例,其中法洛四联症7例;肺动脉闭锁合并室间隔缺损3例;先天性主动脉瓣狭窄2例;右心室双出口合并室间隔缺损和肺动脉狭窄2例;大动脉转位合并室间隔缺损和肺动脉狭窄3例,其中1例合并右心室双出口。②手术方式:肺动脉带单瓣血管片作右心室流出道跨环补片7例,Rastelli术4例,肺动脉-右心室流出道外管道连接术3例,自体肺动脉瓣移植术2例,全腔静脉肺动脉连接术1例。③观察术后早期及随访期间患者的治疗效果。结果:①16例患者手术顺利完成,1例术中心脏复跳后不能脱离体外循环死亡。术后死亡1例,死亡原因为低心排综合征、心力衰竭;其余15例均痊愈出院。②随访1～48个月,15例患者生活质量良好。超声心动图示植入的同种带瓣管道无明显钙化、衰败。结论:液氮深低温保存同种带瓣管道治疗复杂先天性心脏病早、中期效果良好,远期防止同种带瓣管道钙化、衰败是临床进一步的研究重点。

AIM： Valved homograft conduit is frequently used to treat complex congenital heart disease and shows a satisfactory short and moderate-term effect, but its long-term effect still needs to improve. This study evaluated the clinical outcome of cryopreserved self-designed valved homograft conduit in the treatment of complex congenital heart disease. METHODS： Seventeen patients with complex congenital heart disease underwent valved homograft conduit transplantation in Department of Thoracic and Cardiovascular Surgery, Drum Tower Hospital of Medical College of Nanjing University between January 2003 and October 2007, There were 7 cases with Tetralogy of Fallot, 3 cases with pulmonary atresia complicated by ventricular septal defect, 2 cases with congenital aortic valve stenosis, 2 cases with double outlet fight ventricle complicated by pulmonary stenosis, and 3 cases with transposition of the great arteries complicated by with ventficular septal defect and pulmonary stenosis including 1 case complicated with double outlet right ventricle. Homologous transannular graft with valve was used in 7 cases; Rastelli operation was performed on 4 cases; fight ventricular and pulmonary artery homograft on 3, ROSS procedure on 2 and total vena cava pulmonary artery connection on 1, Treatment outcome was observed early after operation and during follow-up. RESULTS： Of 17 patients, 16 completed the surgery, and 1 died of extracorporeal circulation after heart resuscitation during the surgery. One case died of low cardiac output syndrome and heart failure after surgery, The other 15 cases recovered and discharged from hospital. During the follow-up for 1-48 months, the life quality of 15 patients was good, Echocardiography showed no obvious calcification or degeneration was found in the implanted valved homograft conduits, CONCLUSION： Cryopreserved valved homograft conduit has good early and midterm effects in the treatment of complex congenital heart disease, The prevention of valved homograft conduit calcification and degeneration is significant for further clinical study.