小儿永存动脉干右室流出道重建

Reconstruction of right ventrictdar outflow tract for truncus arteriosus in children

目的总结小儿永存动脉干（era）右室流出道重建治疗经验。方法2000年1月至2007年12月共行FrA根治手术治疗43例，男26例，女17例。年龄1．5个月-3．8岁；体重3．2—23．0kg。Ⅰ型、Ⅱ型和Ⅲ型FFA分别为26例、11例和6例。18例PrA的肺动脉直接下拖至右室流出道切口上缘相吻合，前壁再用-tL,包补片扩大；8例用Homograft管道、14例用牛颈静脉管道连接远端肺动脉和右心室，重建右室流出道；3例Ⅱ型者，肺动脉后壁用左心耳壁与右室流出道上缘做吻合，前壁再用心包补片扩大。结果术后所有病儿均生存，5例表现为右心功能不全，2例右肺动脉（RPA）压差37．5—47．3mm Hg（1mmHg=0．133kPa），术后17d恢复至35．3mm Hg以下。左心室流出道阶差均小于20．3mm Hg。残余VSD（2mm）1例，乳糜胸1例。5例病儿肺血管阻力高，吸一氧化氮（NO）治疗7d左右后好转。随访3个月-3年，2例病儿RPA残余压差24．0-29．3mmHg，均无明显右心室或左心室流出道梗阻。结论肺总动脉后壁直接与右心室切口作吻合重建PTA的右室流出道，早期和远期效果良好。牛颈静脉的带瓣管道的应用，解决了小尺寸同种带瓣管道来源不足的问题，操作简便。

Objective To evaluate the surgical results of right ventricular outflow tract reconstruction for persistent truncus arteriosns（VIA） in children. Methods Forty three cases of VIA in babyhood and infant were operated in our hospital from January 2000 to Decenber 2007. Patient cases for the typeⅠ , typeⅡ and type Ⅲwere26,11 and 6 respectively. They aged from 1.5 months to 3.8 years [ （0.9 ±1.7 ） years] and weighted from 3.2 kg to 23.0 kg [ （ 7.5 ±3.8 ） ]. The excised pulmonary root was anastomosed to the edge of incision of the right ventricular outflow tract and a pericardium was used to enlarge the pulmonary anterior wall in 18 cases. Six cases used homografts and 14 cases with cattle jugular vein graft to connect the distal pulmonary artery and the right ventricular outflow tract. In the other 3 eases, the left atrial wall was connected between the pulmonary wall and the right ventrieular outflow tract. Results All the patients were alive. Five patients had fight ventricular dysfunction . A pressure gradient of 37.2 - 47.3 mm Hg in fight pulmonary artery was found in the other 2 cases and was reduced to 〈 35.3 mmHg after 17 days. The pressure gradient in the left ventrieular outflow tract was 〈 20.3 ram Hg. NO was used for one week in 5 cases because of pulomnbary hypertension. In the follow up of 3 - 36 months, the residual pressure gradient in right pulmonary artery was 24.0- 29.3mm Hg in 2 eases. All patients had no right or left ventricular outflow tract obstruction. Conclusion The results for early and mid term follow-up were satisfactory with the recanstruction method described in this paper. The cattle jugular vein graft was convenient to prepare and has different sizes which could meet the shortage of source.