Kanter Kirk R, Budde Jason M, Parks W James, Tam Vincent K H, Sharma Shiva, Williams Willis H, Fyfe Derek A
Department of Surgery, and the Sibley Heart Center, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Ann Thorac Surg. 2002 Jun;73(6):1801-6; discussion 1806-7. doi: 10.1016/s0003-4975(02)03568-3.
Surgical repair of obstructive lesions of the right ventricular outflow tract (RVOT) in children commonly creates pulmonary valve incompetence that may eventually require pulmonary valve replacement (PVR). We reviewed our experience with PVR late after RVOT reconstruction.
We performed 100 PVRs in 93 children 1.1 months to 22.4 years (median 8) after RVOT reconstruction. Children with right ventricular to pulmonary artery conduits and primary PVRs were excluded. Age at PVR was 4.5 months to 27.9 years (median 9.5 years). Initial diagnosis was tetralogy of Fallot and variants, 62; critical pulmonary stenosis, 15; pulmonary atresia with intact ventricular septum, 7; and others, 9. Eleven patients had a redo PVR. A total of 62 PVRs were homografts; 38 were porcine valves.
There was one early death. On follow-up of 5 months to 12.4 years (mean 4.9 years) there were no late deaths although 1 child underwent cardiac transplantation. Actuarial freedom from redo PVR at 8 years was 100% for porcine valves but 70% for homograft valves (p = 0.17). For children younger than 3 years at PVR, freedom from reoperation was 76% at 1 year and 39% at 8 years compared with freedom from redo PVR at 8 years of 100% for children older than 3 years. On latest echocardiogram 97% of porcine valves had mild or no pulmonary regurgitation compared with 72% of homograft valves.
PVR after RVOT reconstruction can be performed with low risk. Porcine valves may be superior to homograft valves although this advantage may be due to older age at time of PVR.
儿童右心室流出道（RVOT）梗阻性病变的外科修复通常会导致肺动脉瓣关闭不全，最终可能需要进行肺动脉瓣置换（PVR）。我们回顾了我们在RVOT重建术后晚期进行PVR的经验。
我们在93名儿童中进行了100次PVR，这些儿童在RVOT重建术后1.1个月至22.4岁（中位数8岁）。排除右心室至肺动脉管道和初次PVR的儿童。PVR时的年龄为4.5个月至27.9岁（中位数9.5岁）。初始诊断为法洛四联症及其变异型62例；重症肺动脉狭窄15例；室间隔完整的肺动脉闭锁7例；其他9例。11例患者进行了再次PVR。总共62次PVR使用的是同种异体移植物；38次使用的是猪瓣膜。
有1例早期死亡。在5个月至12.4年（平均4.9年）的随访中，没有晚期死亡病例，尽管有1名儿童接受了心脏移植。猪瓣膜在8年时无需再次PVR的精算生存率为100%，而异种异体移植物瓣膜为70%（p = 0.17）。对于PVR时年龄小于3岁的儿童，1年时无需再次手术的生存率为76%，8年时为39%，而对于PVR时年龄大于3岁的儿童，8年时无需再次PVR的生存率为100%。在最新的超声心动图检查中，97%的猪瓣膜有轻度或无肺动脉反流，而异种异体移植物瓣膜为72%。
RVOT重建术后进行PVR的风险较低。猪瓣膜可能优于同种异体移植物瓣膜，尽管这种优势可能归因于PVR时年龄较大。
