Rastelli手术治疗右室双出口合并右室流出道及肺动脉瓣严重狭窄

Rastelli procedure for double outlet right ventricle with right outflow tract and pulmonary valve stenosis

目的总结Rastelli手术治疗右室双出口合并右室流出道及肺动脉瓣严重狭窄经验及效果。方法分析23例患者手术治疗的方法及早期疗效。在全麻体外循环下行Rastelli手术,经右心室切口用人工血管片修补室间隔缺损,形成左心室至主动脉的内隧道。切断主肺动脉,闭合近端,用异种带瓣牛颈静脉建立右心室流入道至主肺动脉的外管道。结果20例患者术后恢复良好,3例死亡。结论Rastelli手术是治疗右心室双出口合并右室流出道及肺动脉瓣严重狭窄的满意术式,可以达到根治效果,但远期存在二次手术问题。

Objective To review the results and experiences of Rastelli procedure for double outlet right ventricle （DORV） with right outflow tract and pulmonary valve stenosis. Methods Analysis of 23 cases of patient＇s treatment methods and early efficacy. The Rastelli procedure was performed under cardiopulmonary bypass and general anesthesia. Right ventriculotomy was made to repair the ventricular septal defect （VSD） with artificial blood vessel patch. An internal tunnel was made between the left ventricle and the aorta. The main pulmonary artery was divided and the proximal end was closed. An external valved conduit was reconstructed between the inlet of the right ventricle and the main pulmonary artery by using the bovine jugular vein valved conduit.Results 20 cases of patients with good recovery, three cases of death. Conclusion Rastelli procedure is a satisfactory method for the treatment of DORV with right outflow tract and pulmonary valve stenosis, it can achieve radical cure. But,it has the problems of second surgery in long term.