Uemura H, Yagihara T, Kadohama T, Kawahira Y, Yoshikawa Y
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Cardiol Young. 2001 Jul;11(4):415-9. doi: 10.1017/s1047951101000531.
To investigate our surgical results of intraventricular rerouting in patients having double outlet right ventricle with doubly-committed ventricular septal defect.
We undertook repair in 8 patients with this particular feature. Of these, 2 patients had pulmonary stenosis, and another had interruption of the aortic arch. The subarterial defect was unequivocally related to both the aortic and the-pulmonary orifices in all, albeit slightly deviated towards the aortic orifice in one, and towards the pulmonary orifice in another. Intraventricular rerouting was carried out via incisions to the right atrium and the pulmonary trunk. To ensure reconstruction of an unobstructed pulmonary pathway, a limited right ventriculotomy was made in 5.
All patients survived the procedure, and are currently doing well, with follow-up of 25 to 194 months, with a mean of 117+/-68 months. Catheterization carried out 16+/-6 months after repair demonstrated excellent ventricular parameters. Mean pulmonary arterial pressure was 16+/-7 mmHg, being higher than 20 mmHg in 2 patients. No significant obstruction was found between the right ventricle and the pulmonary arteries. A pressure gradient across the left ventricular outflow tract became significant in one patient in whom a small outlet septum was present, and a heart-shaped baffle had been used for intraventricular rerouting. Reoperation was eventually needed in this patient for treatment of the obstruction, which proved to be progressive.
Precise recognition of the morphologic features is of paramount importance when choosing the optimal options for biventricular repair in patients with double outlet right ventricle and doubly-committed interventricular communication.
探讨双出口右心室合并双室共干室间隔缺损患者行心室内改道手术的效果。
我们对8例具有该特殊特征的患者进行了修复手术。其中，2例患者有肺动脉狭窄，另1例有主动脉弓中断。所有患者的动脉下型缺损均明确与主动脉口和肺动脉口相关，尽管1例略偏向主动脉口，另1例略偏向肺动脉口。通过右心房和肺动脉干切口进行心室内改道。为确保重建无梗阻的肺循环通路，5例患者进行了有限的右心室切开术。
所有患者均顺利度过手术，目前情况良好，随访时间为25至194个月，平均为117±68个月。修复术后16±6个月进行的心导管检查显示心室参数良好。平均肺动脉压为16±7 mmHg，2例患者高于20 mmHg。右心室与肺动脉之间未发现明显梗阻。1例存在小的流出道间隔且使用心形挡板进行心室内改道的患者，左心室流出道出现明显压力阶差。该患者最终需要再次手术治疗梗阻，且梗阻呈进行性发展。
在为双出口右心室合并双室共干室间隔缺损的患者选择双心室修复的最佳方案时，准确识别形态学特征至关重要。
