自制三瓣叶Goretex管道在先天性心脏病患儿右心室流出道重建中的近期结果

Early Clinical Outcomes of Right Ventricular Outflow Tract Reconstruction With Handmade Threevalve Goretex Conduit

目的:总结自制三瓣叶Goretex管道在先天性心脏病(先心病)患儿右心室流出道重建中的近期结果。方法:2016-12至2017-06期间采用自制三瓣叶Goretex管道重建右心室流出道患儿19例,平均年龄(5.9±3.6)岁,平均体重(20.2±8.2)kg。根据患者年龄和体重,制定右心室流出道的直径目标值,将0.1 mm Goretex膜剪裁三片相同大小的椭圆形作为瓣叶,6/0 prolene线单纯连续缝合至Goretex管道,自制成三瓣叶Goretex管道。采集患儿出院时超声心动图评价带瓣管道内瓣口狭窄和反流程度情况,出院后1个月门诊超声心动图复查随访观察。结果:右心室双出口6例,矫正型大动脉转位4例,肺动脉闭锁4例,大动脉转位2例,共同动脉干1例,双根部调转术后外管道狭窄1例,主动脉瓣狭窄1例。单纯Rastelli术8例,Rastelli+Senning术1例,Rastelli+半Mustard术2例,Rastelli+上腔静脉右心房连接术(Glenn take down)2例,Rastelli+双侧双向Glenn例1例,右心室肺动脉外管道置换术3例,Ross术1例,共同动脉干矫治术1例;其中二次手术12例(63.2%)。手术均在体外循环下完成,术后常规阿司匹林(3 mg/kg口服QD)抗栓,全组患者无院内死亡和严重并发症发生,出院及随访时间1个月时超声心动图显示所有患者肺动脉瓣口均无狭窄,2例(10.5%)患者肺动脉瓣轻度反流,其余患者无反流。结论:自制三瓣叶Goretex管道重建先心病右心室流出道近期结果满意,但中远期结果需要进一步随访。

Objectives：To investigate the early clinical outcome of right ventricular outflow tract reconstruction with handmade three-valve Goretex conduit implanted in the pulmonary position.Methods： Goretex conduit was made by three same shaped polytetrafluoroethylene membranes. Nineteen patients underwent pulmonary reconstruction with this handmade conduit were included in this study. Conduit function was investigated by means of review of serial echocardiographic examinations.Results：Mean age and body weight of the included patients were（5.9±3.6） years and（20.2±8.2） kg, respectively. The primary diagnosis of the patients included： double outlet of right ventricle（n=6）,corrected transposition of great arteries（n=4）,pulmonary atresia（n=4）,transposition of great arteries（n=2）,truncus arteriosus（n=1）,obstruction of conduit after DRT（n=1） and aortic stenosis（n=1）. The primary procedure performed was as follows： Rastelli（n=8）,Rastelli＋Senning（n =1）,Rastelli＋hemi-Mustard（n =2）,Rastelli＋Glenn take down（n =2）,Rastelli＋Glenn（n =1）,replacement of conduit between right ventricle and pulmonary artery（n=3）,Ross（n=1）,and correction of truncus arteriosus（n=1）. Twelve patients received second operation（63.2%）. All the procedures were performed with cardiopulmonary bypass. Oral aspirin（3 mg/kg per day） was applied to all patients. There was no in-hospital death and there were no severe complications. Echocardiography examination before discharge showed that there was no pulmonary stenosis in all patients and mild pulmonary regurgitation was evidenced in two patients（10.5%）.Conclusions： Use of the handmade three-valve Goretex conduit to reconstruct the right ventricular outflow tract is safe and feasible and relates to good early clinical outcomes.