牛颈静脉材料重建右心室流出道的近中期临床效果观察

A short and moderate-term outcomes of right ventricular outflow reconstruction with bovine juglar vein

目的:观察牛颈静脉材料重建右心室流出道的近中期临床效果。方法:选取82例先天性心脏病病例,男性45例,女性37例,年龄4个月～30岁,其中肺动脉闭锁合并室间隔缺损18例;法洛四联症55例;右心室双出口3例;大动脉转位3例;肺动脉狭窄1例;共同动脉干1例,术中全部使用牛颈静脉材料重建右心室流出道,术后观察近中期临床结果,如术后并发症病死率,使用超声心动图随访观察肺动脉流速,肺动脉瓣反流情况。结果:82例患者术后早期死亡8例,病死率9%,术后患者不同程度存在肺部渗出,右心功能不全的表现。共随访46例,随访率62%。随访时间3个月～5年,随访期间无死亡。9例(19%)病例出现肺动脉流速增高>3m/s,其中3例接受再次手术,3例(6%)出现肺动脉瓣大量返流。结论:牛颈静脉是合适的右心室流出道重建材料,可以获得较好的近中期效果,有一定的远期狭窄率。本组病例随访率较低,样本量偏小,分布偏倚较大,还需要更大样本的研究。

Objective: To observe the effect of reconstructing right ventricular outflow tract with bovine jugular vein material. Methods: 82 cases of congenital heart disease were selected, of which 45 were male, 37 were women and the age was 4 to 360 months.There were 18 cases of pulmonary atresia with ventricular septal defect, 55 cases of Fallot tetralogy, 3 cases of right ventricular double outlet, 3 case of transposition of aorta, 1 case of pulmonary artery stenosis, and 1 cases of Truncus arteriosis. The right ventricular outflow tract was reconstruction with bovine jugular vein material during operation, the clinical result such as postoperative complications and mortality were observed after operation, and the pulmonary artery velocity and pulmonary valve reflux were observed by echocardiography. Results: 8 patients died and the mortality rate was 9%. Postoperative patients had different degrees of pulmonary exudation and right ventricular dysfunction. A total of 46(62%) patients were followed up. The follow-up range from 3 to 60 months and no death occurred during the follow-up period. 9 cases(19%) were diagnosed with conduit stenosis, and 3 of them received reoperation. Serious pulmonary valve regurgitation occurred in 3 patients(6%). Conclusions: The durability of BJV conduits was suboptimal after a short and medium term follow-up, and conduit stenosis is often detected. Future large-scale and prospective studies with a longer follow-up period are warranted.