右心行旁路手术后室间隔完整的肺动脉闭锁患者的左室功能

The left ventricular performance in patients with pulmonary atresia with intac t ventricular septum who were Fontan candidates before and after the bidirection al Glenn procedure and a staged total cavopulmonary connection was compared with that in patients with tricuspid atresia. Contractility(end-systolic elastance) , afterload(effective arterial elastance), and ventricular efficiency(ventriculo arte-rial coupling, arterial elastance/end-systolic elastance ratio), and the ratio of stroke work and pressure-volume area were approximated on the basis of cardiac catheterization data before the bidirectional Glenn procedure, before and after staged total cavopulmonary connection, and approxi mately 1 year after the completion of total cavopulmonary connection in 20 patie nts with pulmonary atresia with intact ventricular septum and 21 patients with t ricuspid atresia. The end-systolic elastance of the pulmonary atresia with inta ct ventricular septum group was significantly inferior to that of the tricuspid atresia group after bidirectional Glenn procedure and total cavopulmonary connec tion(1 year after total cavopulmonary connection 1.85 0.51 mm Hg m2 mL-1 vs 2.8 4 0.96 mm Hg m2 mL-1, P . 01). The arterial elastance was not different between groups throughout the assessment period and tended to increase in a stepwise fa shion after bidirectional Glenn procedure and total cavopulmonary connection. Th e arterial elastance/end-systolic elastance ratio and ratio of stroke work and pressure-volume area of the pulmonary atresia with intact ventricular septum gr oup tended toworsen,whereas those of the tricuspid atresia group tended to impro ve. The difference reached statistical significance 1 year after total cavopulmo nary connection(1.15 0.35 vs 0.82 0.23 and 64.2%6.7%vs 71.3%5.7%, respective ly, P . 05 and P . 05, respectively). The contractility and ventricular efficien cy of patients with pulmonary atresia with intact ventricular septum are inferio r to those of patients with tricuspid atresia after bidirectional Glenn procedur e and total cavopulmonary connection. A high-pressure residual right ventricle may impair the left ventricular performance of patients with pulmonary atresia w ith intact ventricular septum after bidirectional Glenn procedure and total cavo pulmonary connection.

利用人工腱索修复儿童二尖瓣的中期疗效

We have used artificial chordal replacement with expanded polytetrafluoroethylene sutures for mitral valve repair in children and reported favorable early clinical results. In this article we evaluate the midterm results of mitral valve repair with expanded polytetrafluoroethylene sutures in 39 children. From April 1995 through September 2003, mitral valve repair with chordal replacement using expanded polytetrafluoroethylene sutures was performed in 39 patients. In all patients the preoperative grade of mitral regurgitation was moderate or more because of prolapse of the anterior mitral leaflet. The mean age and body weight at the time of the operation were 4.7±5.3 years(range, 1 month to 17.8 years) and 14.4±12.2 kg(range, 3.9-54.4 kg), respectively. The number of expanded polytetrafluoroethylene sutures ranged from 1 to 3(mean, 1.4). The mean follow-up period and body weight at the latest follow-up were 5.0±2.3 years(range, 1.1-8.5 years) and 25.7±16.4 kg(range, 6.9-73 kg), respectively. There were no operative or late deaths. Only one patient required mitral valve replacement, which occurred 17 days after repair. Two patients underwent redo mitral valve repair 2 and 5 years after initial repair, respectively. The actuarial freedom from reoperation at 5 and 8 years was 94.8%and 89.5%, respectively. At the latest follow-up, trivial or less mitral regurgitation was observed in 33(84.6%) patients. Mitral valve repair with expanded polytetrafluoroethylene sutures in children demonstrated favorable midterm outcome. The procedure is safe and effective,with potential for patients’growth.