非常规右心室切口根治法洛四联症

The experience of minimal invasive right ventricle for repair of tetralogy of Fallot

目的：采用非常规右心室切口手术的方法根治法洛四联症（TOF）。方法：2005年5月至2008年2月采用经右心房/肺动脉途径外科根治TOF患者83例。年龄5个月~25岁,平均（22.33±6.41）个月;体质量6.5-51.5 kg,平均（13.18±4.48）kg。28例采用单纯右心房切口;51例右心房加肺动脉联合切口,其中42例跨肺动脉瓣环补片扩大右心室流出道（右心室切口长5-20 mm）;另4例经右心房及右心室小切口进行右心室流出道疏通。室间隔缺损经右心房切口连续缝合补片修复81例,另2例经右心房/肺动脉切口2侧修复。结果：术中停止体外循环后,65例采用直接心脏表面穿刺或通过漂浮导管检测,收缩期右心室压/体循环压（RVP/SAP）比值为0.3-0.81,平均（0.41±0.15）;收缩期右心流出道残存压差（GRVP-PAP）为8-55 mm Hg（1 mm Hg=0.133 kPa）。术后早期死亡1例。结论：采用右心室微创的手术方法根治法洛四联症在技术上是可行的,操作简单,早期临床效果满意,对中晚期结果可能有潜在的益处。

Objective ： To report the preliminary experiences of transatrial-transpulmonary repair of tetralogy of Fallot.Method：83 patients with tetralogy of Fallot underwent total correction during the period from May 2005 to Feb 2008. Their ages ranged from 5 months to 25 years [mean （22.33 ± 6.41 ） months] ; Weight ranged from 6.5-51.5 kg[mean （13.18 ± 4.48）kg]. The infundibular mobilization and resection was made through atrialtomy in 28 patients, through atrialtomy-pulmonary arteriotomy in 51 patients, and transatril-a small right ventricular incision in the other 4 cases. For 42 patients, the pulmonary incision was extended via the small pulmonary annulus for 5 to 20 mm onto the right ventrieular free wall. The ventricular septal defect was closed through the right atrium in 81 patients and via right atrial-pulmonary artery in 2 patient with subpulmonary defect. Result： The ratio of systolic right ventricular pressure to systemic arterial pressure was 0.3-0.81 （0.42 ±0. 15 ）. The residual gradient pressure from right ventricle to pulmonary artery was 8-55 mm Hg（1 mm Hg = 0.133 kPa）. Residual shunt was not found at ventricular septum by echoeardiogram in all patients. One patient were died in the early postoperative period. Conclusion：This report indicates that successful repair of tetraloty of Fallot can be accomplished by a transatrialtranspulmonary approach with minimal invasive right ventricle, which may provide a more intact right ventricle morphologically.