Barbero-Marcial M, Tamanati C, Jatene M B, Aiello V D, Baucia J A, Atik E, Kajita L J, Ebaid M, Verginelli G, Jatene A D
Heart Institute, Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, Brazil.
Heart Surg Forum. 1998;1(2):125-9.
Introduce a new surgical technique for biventricular correction of double-outlet right ventricle with noncommitted ventricular septal defect.
From April 1987 to February 1996, 15 patients with double-outlet right ventricle with noncommitted ventricular septal defect were operated on using a new technique for biventricular repair with multiple bovine pericardial patches to create a tunnel between the left ventricle and the aorta. Ages ranged from two months to 13 years (mean age 4.8 years). Thirteen patients had situs solitus and levocardia, one patient had situs inversus and dextrocardia, and one patient had situs solitus and dextrocardia. Construction of the tunnel began at the right atrium. The ventricular septal defect (VSD) was enlarged anteriorly, if restrictive or small, and the first patch was sutured in the infero-posterior edge of the VSD. The second, third and sometimes the fourth patches were sutured in sequence, through the right ventriculotomy, directing the tunnel to the aortic annulus.
Overall mortality was 20%, with two early and one late death. The surviving patients were followed-up for a period ranging from ten months to nine years (mean 33 months), and all were in functional class I (NYHA). Minimal residual ventricular septal defect was observed in one patient, stenosis in two patients and moderate pulmonary insufficiency in one. There was no obstruction of the intraventricular tunnel between the LV and the aorta.
Based on these data, we conclude that this technical modification for the biventricular repair of the double-outlet right ventricle with noncommitted VSD allows for the construction of a tunnel with adequate internal diameter, respecting the spatial changes between the VSD and aorta. In addition, the intraventricular bovine pericardial tunnel takes up less space, thus reducing the incidence of right ventricle outlet obstruction.
介绍一种用于矫正右心室双出口合并非限制性室间隔缺损的双心室手术新技术。
1987年4月至1996年2月，对15例右心室双出口合并非限制性室间隔缺损的患者采用一种新的双心室修复技术，使用多个牛心包补片在左心室和主动脉之间构建隧道。年龄范围为2个月至13岁（平均年龄4.8岁）。13例患者心脏位置正常且心尖朝左，1例患者心脏位置镜像且心尖朝右，1例患者心脏位置正常但心尖朝右。隧道构建从右心房开始。如果室间隔缺损（VSD）狭窄或较小，则向前扩大，第一个补片缝合在VSD的后下缘。第二个、第三个有时还有第四个补片依次缝合，通过右心室切口，将隧道引向主动脉瓣环。
总体死亡率为20%，2例早期死亡，1例晚期死亡。存活患者随访时间为10个月至9年（平均33个月），所有患者心功能均为I级（纽约心脏协会分级）。1例患者观察到极小的残余室间隔缺损，2例患者有狭窄，1例患者有中度肺动脉瓣关闭不全。左心室和主动脉之间的室内隧道无梗阻。
基于这些数据，我们得出结论，这种用于右心室双出口合并非限制性室间隔缺损双心室修复的技术改良能够构建内径足够的隧道，同时考虑到室间隔缺损和主动脉之间的空间变化。此外，室内牛心包隧道占用空间较小，从而降低了右心室流出道梗阻的发生率。
