肺动脉后壁扩大法矫治合并左肺动脉狭窄的法洛四联症

Widening Pulmonary Arterial Posterior Wall for Tetralogy of Fallot Repair Patients Complicated with Left Pulmonary Artery Stenosis

目的 总结采用肺动脉后壁扩大法矫治合并左肺动脉狭窄的法洛四联症（TOF）的手术技术要点及效果。方法 2008年1月至2014年8月共1 142例患者在我院行TOF矫治术，合并左肺动脉严重狭窄的患者44例。其中21例采用肺动脉后壁扩大矫治左肺动脉狭窄的手术策略。年龄1个月至11岁，平均（22.8±33.9） 个月，体重3.8～29.0（9.1±5.3） kg。结果 1例术中死亡，20例长期生存。4例术后出现单侧右肺渗出。心脏彩色超声心动图随访3～72个月，14例左肺动脉处无压差，6例残留压差（32.8±12.7） mm Hg。1例压差逐渐增大行介入球囊扩张。结论 肺动脉后壁扩大法可有效矫治TOF合并的左肺动脉狭窄，扩大后补片，血流方向更顺畅。切断动脉导管可减少牵拉导致的肺动脉扭曲。同时该术式增加新建肺动脉的自体组织，有更好的生长潜力。

Objective In order to correct left pulmonary artery （LPA） stenosis in tetralogy of Fallot （TOF）, a technique for LPA reconstruction by widening pulmonary arterial posterior wall was devised. To evaluate its surgical technique as well as postoperative outcome. Methods From January 2008 through August 2014 year, 1 142 consecutive patients underwent repair of TOF including 44 patients with TOF and LPA stenosis in our hospital. We used widening pulmonary arterial posterior wall for LPA reconstruction in 21 patients. The median age was 22.8 months （range,1 month to 11 years）, and the median weight was 9.1 kg （range, 3.8-29 kg）. Results There was one operative death. No death occurred during the follow-up period in the other 20 patients. There were 4 patients with complicate unbalanced pulmonary perfusion postoperatively. Echocardiography at 3-72 months follow-up demonstrated no obvious stenosis was found at LPA in 14 patients, and mild stenosis （32.8±12.7 mm Hg） in 6 patients. Only 1 patient required further interventions because of restenosis of LPA. Conclusions LPA reconstruction by widening pulmonary arterial posterior wall is an effective method in the management of stenosis of LPA in the patients with TOF. We emphasize division of the arterial duct or ligamentum completely because it will tether and kink the LPA. This procedure retains the better growth potential by increasing autogenous tissue of native tissue.