Boudjemline Younes, Bonnet Damien, Massih Tony Abdel, Agnoletti Gabriella, Iserin Franck, Jaubert Francis, Sidi Daniel, Vouhé Pascal
Service de Cardiologie Pédiatrique, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75743 Paris Cedex 15, France.
J Thorac Cardiovasc Surg. 2003 Aug;126(2):490-7. doi: 10.1016/s0022-5223(03)00232-0.
We evaluate early results of bovine jugular vein conduits in the pulmonary outflow.
Between April 2000 and September 2001, 31 conduits were placed in the outflow of the right ventricle. Patients who received a conduit as a staged surgical procedure were excluded (n = 3). Implantation age ranged from 0 to 21 years (median, 3.4 years). Conduit diameter ranged from 12 to 20 mm (median, 14 mm). Transthoracic echocardiography was performed at discharge and 3 months after surgery. Patients with significant pulmonary regurgitation and/or stenosis underwent cardiac catheterization.
Four patients died during the follow-up period. Three deaths were unrelated to the conduit. One death was related to the complete thrombosis of the conduit. At 3 months evaluation, pulmonary valve regurgitation was absent or trivial in 19, mild in 2 and severe in 3 of 24 survivors. Four patients had nonfatal conduit-related complications. A transient thrombus formation within 1 leaflet was noted postoperatively in a patient with a moderate pulmonary regurgitation. Three patients required reoperation 3 to 5.8 months after the implantation for conduit failure (mean, 4.3 months). Cardiac catheterization before replacement revealed an aneurysmal dilation of the conduit below a severe stenosis of the pulmonary bifurcation due to important neointimal proliferation.
Early failure of bovine jugular vein valved conduits can occur because of exaggerated intimal proliferation or thrombotic process within the conduit. Because of these complications, close echocardiographic follow-up is mandatory during the first weeks after implantation.
我们评估牛颈静脉管道用于肺流出道的早期效果。
在2000年4月至2001年9月期间，31根管道被植入右心室流出道。接受分期手术植入管道的患者被排除（n = 3）。植入年龄范围为0至21岁（中位数为3.4岁）。管道直径范围为12至20毫米（中位数为14毫米）。出院时及术后3个月进行经胸超声心动图检查。有明显肺反流和/或狭窄的患者接受心导管检查。
4例患者在随访期间死亡。3例死亡与管道无关。1例死亡与管道完全血栓形成有关。在3个月评估时，24名幸存者中，19例无或仅有轻微肺瓣反流，2例为轻度，3例为重度。4例患者发生与管道相关的非致命性并发症。1例中度肺反流患者术后在1个瓣叶内出现短暂血栓形成。3例患者在植入后3至5.8个月（平均4.3个月）因管道故障需要再次手术。置换前的心导管检查显示，由于重要的内膜增生，在肺动脉分叉严重狭窄下方的管道出现瘤样扩张。
牛颈静脉带瓣管道早期失败可能是由于管道内内膜过度增生或血栓形成过程所致。由于这些并发症，植入后的头几周必须进行密切的超声心动图随访。
