Tchervenkov C I, Pelletier M P, Shum-Tim D, Béland M J, Rohlicek C
Division of Cardiovascular Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
J Thorac Cardiovasc Surg. 2000 Feb;119(2):314-23. doi: 10.1016/S0022-5223(00)70187-5.
The purpose of this study was to review our results with an approach of early primary repair for tetralogy of Fallot or double-outlet right ventricle with anomalous coronary arteries, using several techniques to minimize the use of a conduit.
Twenty consecutive neonates and infants with anomalous coronary arteries crossing an obstructed right ventricular outflow tract underwent primary repair. Median age was 5.5 months and mean weight 6.22 kg. The anomalous coronary arteries included the left anterior descending from the right coronary artery (n = 10), the right coronary artery from the left anterior descending (n = 1), the left anterior descending from the right sinus (n = 1), and a significant conal branch from the right coronary artery (n = 7) or left anterior descending (n = 1). Two neonates had pulmonary atresia. The right ventricular outflow tract was reconstructed without a conduit in 18 patients, including those with pulmonary atresia. Surgical techniques included main pulmonary artery translocation in 4 patients, transannular repair under a mobilized left anterior descending coronary artery in 2 patients, and displaced ventriculotomy with subcoronary suture lines in 8 patients. In 4 patients the right ventricular outflow tract was repaired via the ventriculotomy and/or pulmonary arteriotomy. A homograft was used as the sole right ventricle-pulmonary artery connection in 1 patient and in another a homograft was added to a hypoplastic native pathway.
There have been no early or late deaths. The right ventricular/left ventricular pressure ratio within 48 hours of the operation was 0.47 +/- 0.10. There were 2 reoperations at 8 and 11 years after the operation, during a mean follow-up of 5.2 years (1-11.3 years).
Primary repair of tetralogy of Fallot or double-outlet right ventricle with anomalous coronary arteries can be done in neonates and infants with excellent results. Alternative surgical techniques for right ventricular outflow tract reconstruction, such as main pulmonary artery translocation, can avoid the use of a conduit in most patients.
本研究的目的是回顾我们采用早期一期修复法治疗法洛四联症或右心室双出口合并冠状动脉异常的结果，运用多种技术尽量减少管道的使用。
连续20例患有跨越梗阻性右心室流出道的冠状动脉异常的新生儿和婴儿接受了一期修复。中位年龄为5.5个月，平均体重6.22千克。异常冠状动脉包括起源于右冠状动脉的左前降支（n = 10）、起源于左前降支的右冠状动脉（n = 1）、起源于右窦的左前降支（n = 1），以及起源于右冠状动脉（n = 7）或左前降支（n = 1）的粗大圆锥支。2例新生儿患有肺动脉闭锁。18例患者（包括患有肺动脉闭锁的患者）在未使用管道的情况下重建了右心室流出道。手术技术包括4例患者采用主肺动脉移位术、2例患者在游离的左前降支冠状动脉下进行跨环修复、8例患者采用带冠状动脉下缝合线的移位心室切开术。4例患者通过心室切开术和/或肺动脉切开术修复右心室流出道。1例患者使用同种异体移植物作为唯一的右心室 - 肺动脉连接，另1例患者在发育不良的天然通道上添加了同种异体移植物。
无早期或晚期死亡病例。术后48小时内右心室/左心室压力比为0.47±0.10。在平均5.2年（1 - 11.3年）的随访期间，术后8年和11年有2例再次手术。
患有冠状动脉异常的法洛四联症或右心室双出口的新生儿和婴儿可以进行一期修复，效果良好。右心室流出道重建的替代手术技术，如主肺动脉移位术，可在大多数患者中避免使用管道。
