自制带单瓣管道重建右心室-肺动脉连接治疗复杂先天性心脏病

Reconstruction of right ventricular outflow tract with self-made single-valve conduit for complex congenital heart disease

目的总结自制带单瓣管道重建右心室-肺动脉连接治疗复杂先天性心脏病的经验,探讨术中操作要点,评估该疗法的近中期结果。方法回顾性分析我科2006年1月至2018年6月利用自制带单瓣管道外科治疗的65例复杂先天性心脏病患者的临床资料。其中男42例、女23例,年龄5~23(9.9±4.2)岁,体重15~65(26.2±9.9)kg。根据所使用带单瓣管道将患者分为两组:带单瓣人工血管组19例,带单瓣牛心包管组46例。其中室间隔缺损(VSD)合并肺动脉闭锁(PA)48例,矫正性大动脉转位合并肺动脉狭窄10例,法洛四联症合并单支冠状动脉畸形5例,右室双出口合并肺动脉狭窄及单支冠状动脉畸形2例。结果术后早期死亡2例,均为VSD/PA行人工血管外管道根治患者。术中测右室流出道压差:人工血管组13~37(25.2±4.9)mm Hg,牛心包管组5~23(10.5±3.3)mm Hg。出院时心脏彩超显示外管道内无明显反流。术后失访1例,随访时间8个月至13年。随访期间,三尖瓣中度反流5例,管道内中度反流32例,右室流出道重度梗阻7例,中度梗阻11例,轻度梗阻25例。无中晚期死亡。心功能分级(NYHA)Ⅰ~Ⅱ级,活动耐量良好。结论自制带单瓣外管道重建右心室-肺动脉连接临床效果良好,牛心包管道术中流出道压差小于人工血管,我们更推荐牛心包管用于低龄、低体重患者。

Objective To summarize the experience of right ventricular outflow tract reconstruction with selfmade single-valve conduit for the treatment of complex congenital heart disease,and to explore the key points of operation,and to evaluate the short-term and medium-term results of the treatment.Methods We retrospectively analyzed the clinical data of 65 patients with complex congenital heart disease treated by self-made single-valve conduit from January 2006 to June 2018.There were 42 males and 23 females aged 5-23(9.9±4.2)years with weight 15-65(26.2±9.9)kg.There were 19 patients with single valve artificial blood vessel(an artificial vascular group),and 46 patients with single valve bovine pericardium tube(a bovine pericardial tube group).There were 48 patients of ventricular septal defect(VSD)with pulmonary atresia(PA),10 patients of corrective transposition of great artery with pulmonary artery stenosis,5 patients of tetralogy of Fallot with single coronary artery malformation,2 patients of double outlet of right ventricle with pulmonary artery stenosis and single coronary artery malformation.Results Two patients died early after operation,both of them were VSD/PA patients who underwent radical treatment of extravascular prosthesis.The right ventricular outflow tract pressure difference was 13-37(25.2±4.9)mm Hg in the artificial vascular group and 5-23(10.5±3.3)mm Hg in the bovine pericardial tube group.No obvious reflux was found at discharge.The patients were followed up for 8 months to 13 years.One patient was lost.During the follow-up period,there were 5 patients of moderate tricuspid regurgitation,32 patients of moderate intraductal regurgitation,7 patients of severe right ventricular outflow tract obstruction,11 patients of moderate obstruction and 25 patients of mild obstruction.There was no late death.Heart function classification of all patients was in New York Heart Association classⅠtoⅡ.Conclusion The self-made singlevalve conduit used to reconstruct right ventricular outflow tract shows good clinical effect.Using bovine pericardium tube has less pressure difference of outflow tract in comparison with artificial blood vessel.Bovine pericardium tube is more recommended for young and low weight patients.