摘要
背景:有文献提出在Norwood手术中建立右室-肺动脉连接(RV-PA)管道可增加术后血流动力学稳定性。带瓣管道可更进一步减低右室容量负荷。在本文中报道了关于这项改良的临床经验。方法和结果:从2002年2月至2005年8月,作者共为88例连续病例施行Norwood手术同时建立RV-PA管道。作者为66例患者(54例为肺动脉,12例为同种主动脉)采用冷冻保存的聚四氟乙烯(PTFE)同种带瓣管道,14例采用其他带瓣管道,8例采用无瓣PTEF管道。院内生存率为88.6%,第1年后增高至93.1%。
BACKGROUND -The use of a right ventricle to pulmonary artery(RV-PA) conduit in the Norwood procedure has been proposed to increase postoperative hemodynamic stability. A valve within the conduit should further decrease RV volume load. We report our clinical experience with this modification. METHODS AND RESULTS -From February 2002 through August 2005, we performed 88 consecutive Norwood procedures using RV-PA conduits. We used composite valved conduits made from cryopreserved homograft and polytetra-fluoroethylene(PTFE) in 66 cases(54 pulmonary, 12 aortic homografts), other valved conduits in 14, and unvalved PTFE in 8 cases. Hospital survival was 88.6%overall and increased to 93.1%after the initial year. Early interventions were required in 18 patients(16 for cyanosis). Prestage II cardiac catheterization was performed at a mean age of 126 days. Mean Qp/Qs was 1, with mean aortic saturation 71%, mean O2 extraction 24%, and mean right ventricular end-diastolic pressure 9 mm Hg. Patient weight, use of an aortic homograft valve in the conduit, stage I palliation within the first year of our experience, and low O2 extraction and high transpulmonary gradient prestage II were risk factors for overall death. Early interventions were more frequent in aortic valve conduits compared with all other conduits. CONCLUSIONS -The valved RV-PA conduit was associated with low early mortality after the Norwood procedure. The majority of these patients had normal cardiac output and well-maintained RV function. There may be a higher risk for early conduit interventions and death when aortic valve homografts are used in the RV-PA conduit.
