液氮深低温保存同种带瓣血管的临床应用

Clinical Application of Cryopreserved Valved Homograft Conduit

目的报告应用液氮深低温保存的同种带瓣血管(valved homograft conduit,VHC)纠治复杂心脏畸形的经验。方法患者男27例,女19例,年龄1.9～31(9.5±5.1)岁,体质量10～64(29.5±13.2)kg。病种包括右室双出口15例,矫正性大动脉转位9例,共同动脉干7例,肺动脉闭锁5例,法乐氏四联症4例,完全性大动脉转位3例,先天性主动脉瓣关闭不全2例,法乐氏四联症术后肺动脉瓣重度关闭不全1例。合并畸形包括肺动脉狭窄、房间隔缺损、动脉导管未闭、多发室间隔缺损等。手术均在全麻低温体外循环下进行。结果无手术死亡。早期死亡2例,分别为术后低心排综合症和呼吸道出血。存活44例,随访(32/44)3～96(30±19.5)月,死亡2例,1例右室双出口患者术后26个月死于感染性心内膜炎,另1例为矫正性血管转位患者术后8个月死亡,死因不明。其余30例患者心功能明显改善,超声心动图检查显示吻合口无狭窄,VHC管腔通畅,瓣膜无明显返流。结论液氮深低温保存的VHC是理想的人工材料,用于纠治复杂心脏畸形可获得较好的治疗效果。

Objective To review the experience of cryopreserved valved homograft conduits（VHC） for complicated heart malformation. Methods Forty-six patients with heart malformation underwent surgical correction and right ventricular outflow tract was reconstructed using VHC from March 1999 to September 2005. The age ranged from 1.9 to 31（9.5 ± 5.1） years. The body weight ranged from 10 to 64（29.5 ± 13.2） kg. The cardiac abnormalities included double outlet right ventricle in 15,corrected transposition of the great arteries in 9,truncus arteriosus in 7,pulmonary atresia in 5,tetralogy of Fallot in 4,complete transposition of the great arteries in 3,congenital aortic incompetence in 2,severe pulmonary incompetence after repair of tetralogy of Fallot in 1. The associated intracardiac abnormalities included pulmonary stenosis,atrial septal defect,multiple ventricular defect and so on. Results There was no operative death. One case died of low cardiac syndrome and another died of respiratory tract bleeding. The other 44 cases recovered and discharged from hospital. During the follow-up（32/44） for 3 to 96（30 ± 19.5） months,one died from infective endocarditis 26 months after the operation and another with corrected transposition of the great arteries died suddenly from no explainable cause 8 months after the operation. The remaining 30 patients were in NYHA I or II. Follow-up echocardiography showed that the conduits were in good condition. Conclusion The satisfactory results indicate that VHC is the ideal material for the treatment of the complicated heart malformation.