牛心包补片修复心脏间隔缺损的应用

Tissue engineering bovine pericardium patch in repair of heart defects

背景:心脏涤纶补片因其质地薄、质量轻、生物相容性好等优点常规用于心脏手术,但最近几年发现,用心脏涤纶补片对心室间隔缺损修补后,一旦发生术后残余漏,较易引起溶血、细菌或真菌感染。目的:探讨应用牛心包补片修复心脏间隔缺损的疗效。方法:采用戊二醛固定的牛心包补片修补152例心脏间隔缺损患者,其中房间隔缺损56例,室间隔缺损78例,部分房室间隔缺损18例。术后复查心电图、胸片、心脏超声,观察其术后早期病情、血流动力学和心脏功能。结果与结论:152例患者均完成修补手术,术后无早期死亡,患者随访2-6个月,牛心包补片在使用过程中及术后早期均未发现漏血、溶血、血栓、感染、排斥反应等并发症。1例患者因合并肺动脉高压,术后第1天出现高血压危象,经过抢救后好转。复查心电图、胸片、心脏超声可见心脏间隔缺损修补完全,无残余分流;肺动脉压力明显下降;活瓣已关闭无分流;心脏功能正常。证实牛心包补片可以有效修复心脏间隔缺损,改善患者的血流动力学和心功能,近期效果满意,是一种良好的心脏间隔缺损修补材料。

BACKGROUND： Terylene mesh has been routinely used for cardiac surgery because of its thin texture, light weight and good biocompatibility, but in recent years, we have found that ventricular septal defect repaired with terylene mesh can cause postoperative residual leakage which is prone to cause hemolysis, bacterial or fungal infection. OBJECTIVE： To explore the effect of bovine pericardium patch in repairing of congenital heart septal defect. METHODS： A total of 152 cases of heart septal defects were treated with glutaraldehyde-fixed bovine pericardium patch, including 56 cases of atrial septal defect, 78 cases of ventricular septal defect, 18 cases of partialatrioventricular septal defect., The early illness status, hemodynamic and cardiac functions were observed by re-examining electrocardiogram, chest radiography, cardiac ultrasound and laboratory examination after surgery. RESULTS AND CONCLUSION： All the 152 cases received the repair surgery without postoperative death, and the patients were followed-up for 2-6 months. No bleeding, hemolysis, thrombus, infection or rejection were observed when using the bovine pericardium patch and at eady postoperative period. There was only one patient with pulmonary hypertension caused hypertensive crisis on the first postoperative day and recovered after the emergency treatment. Re-examining electrocardiogram, chest radiography and cardiac ultrasound showed the heart septal defects were repaired completely without residuai shunt, the pulmonary artery pressure was decreased significantly, the valve was closed without shunt, the cardiac function was in the normal level. The results indicate that bovine pericardium patch can repair heart septal defects effectively, improve the hemodynamics and cardiac function with satisfactory short-term effect, it is a favorable material used for repairing the heart septal defects.