膨体聚四氟乙烯片作单瓣重建右室流出道术后早期并发症及处理

Early Complications and its Management after Right Ventricular Outlet Tract Reconstruction with Gore-tex Monocusp Valve

目的：评价膨体聚四氟乙烯片（Gore-Tex片）作肺动脉单瓣重建右室流出道（RVOT）的近期疗效。方法：2002年6月-2011年11月对75例先天性心脏病合并肺动脉狭窄或闭锁的患者旋行矫治手术，术中采用厚度0．1mm的Gore—Tex片作肺动脉单瓣重建RVOT，其中男42倒，女33例。法洛四联症合并肺动脉狭窄57例，l型肺动脉闭锁10例．肺动脉瓣缺如4例，右心室双出口台并肺动脉狭窄2例．完全型大动脉转位1例，室间隔缺损1例，肺动脉狭窄1例。结果：术后血氧饱和度为96％～100％。动脉血氧分压82～207mmHg，右室／左室收缩压比值0．22～0．70，右室与左、右肺动脉间的压力阶差小于10mmHg。左室射血分数（LVEF）0．53～O．80，右室射血分数（RVEF）0．52～071，左室舒张末期容积指数（LVEDI）0，28～0．62ml／m2。术后早期并发症：心包积液7例，低氧血症（氧合指数〈150）6例。心律失常5例，低心排血量综合征4例．残余室间隔缺损4例。术后随访3～48个月，无死亡和并发症的发生。其中62~Gore-Tex片作肺动脉单瓣重建右心室流出道（RVOT）早期瓣膜活动功能正常，13例单瓣固定在开放状态：72倒均无肺动脉单瓣狭窄．3例单瓣轻度狭窄；21倒肺动脉瓣轻度返流．5例中度返流。结论：采用厚度0．Imm的Gote-Tex片作单瓣重建RVOT，可获得满意的lI缶床和血流动力学效果．近期效果良好。膨体聚四氟乙烯片作单瓣重建右心室流出道术后早期并发症应引起高度熏视，加强术后监护及综合治疗措施，及时纠正术后低心输出量综合征．积极防治术后心律失常等均为提高手术成功率的重要因素。

Objective： To evaluate the efficacy of reconstruction of right ventricular outlet tract（RVOT）with 0.1 mm Gore-Tex monocusp valve for short term. Methods： Between June 2002 to June 2010, 75 patients （42 male, 33 female） underwent reconstruction of RVOT with Gore-Tex monocusp valve to correct cardiac anomalies, including 57 patients with tetralogy of Fallot （TOF） and pulmonary stenosis, 10 patients with TOF and pulmonary atresia, 4 patients with TOF and absent pulmonary valve, 2 patients with double outlet of right ventricle and puhnonary stenosis, 1 patient with truncus arterious and 1 patient with complete transposition of great artery, ventricular septal defect and pulmonary stenosis. Results： There was no operative death. The postoperative blood oxygen saturation was up to 96%-100%. PaO2 was 82-207mmHg. The ratioes of right ventricular systolic pressure and left ventricular systolic pressure were between 0.22 to 0.70.The gradient between right ventricle and left or right pulmonary artery was less than 10 mmHg; Left ventricular ejection fraction （LVEF） was 0.53-0.80, right ventricular ejection fraction （RVEF） was 0.52-0.71, left ventricular end-diastolic volume index was 0.28-0.62ml/m2. Early postoperative complications： hypoxemia （oxygenation index 〈150） in 6 cases, low cardiac output syndrome in 4 cases, arrhythmia in 5 cases, 7 cases pericardial effusion, 4 cases of residual ventricular septal defects. All patients were followed up including echocardiography ranged from 3 to 48 months. There were no late death and complications. 62 cases early valve activities function was normal, 13 patients single lobe fixed in the open state, 72 patients were not pulmonary stenosis, 3 patients mild stenosis： 21 cases mild pulmonary valve regurgitation, 5 cases moderate regurgitation. Conclusion： The results suggest that reconstruction of RVOT with 0.1 mm Gore-Tex monocusp valve can secure a satisfactory clinical and hemodynamic effects of the recent good results.Strict, intensive surveillance and promptly synthesized treatment tbr low cardiac output syndrome, cardiac arrhythmia can improve the operative results, Early therapy may effectively avoid negative consequence of postoperative serious complication.