Yaku H, Yagihara T, Kishimoto H, Isobe F, Yamamoto F, Nishigaki K, Fujita T, Takahashi O, Kamiya T, Naito Y
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1992 Aug;40(8):1182-8.
Total repair for truncus arteriosus using an external conduit was performed in 12 patients from 1978 through 1989. Six cases were infants (mean age: 3.4 months) and 6 were children (mean age; 1 years 9 months). Two cases had Collet-Edwards type II truncus and the other 10 cases had type I truncus. One of the infants was associated with an interruption of the aorta and another had a severe regurgitation of the truncal valve (TrV). For external conduits, we used a non-valved conduit in one infant, a composite valved conduit of Dacron containing a heterograft valve in 4 children and a valved pericardial roll made of an autologous or porcine pericardium in 5 infants and 2 children. One infant with a severe regurgitation of the TrV needed valve replacement along with enlargement of the annulus of the TrV. One infant who had replacement of the TrV died early postoperatively. Another infant died 10 months after total repair due to an infection of an external conduit. Cardiac catheterization was performed in all 10 survivors. The mean value for the systolic pulmonary/systemic pressure ratio decreased from 0.98 +/- 0.09 preoperatively to 0.36 +/- 0.09 postoperatively. Replacement of an external conduit was performed due to a conduit stenosis in 2 children and 1 infant, 10 years and 2 months, 7 years and 9 months, and 1 year and 8 months after the total repair, respectively. In one of these 2 children, replacement of the aortic valve was performed due to a severe aortic regurgitation. We conclude that our results of total repair for truncus arteriosus were satisfactory. However, it remains to be solved how to manage an infant with truncus arteriosus associated with a severe regurgitation of the TrV.
1978年至1989年期间，对12例患者进行了使用外部管道的动脉干完全修复术。其中6例为婴儿（平均年龄：3.4个月），6例为儿童（平均年龄：1岁9个月）。2例为Collet-Edwards II型动脉干，其余10例为I型动脉干。1例婴儿合并主动脉中断，另1例动脉干瓣膜（TrV）严重反流。对于外部管道，我们在1例婴儿中使用了无瓣膜管道，在4例儿童中使用了含异种移植瓣膜的涤纶复合带瓣管道，在5例婴儿和2例儿童中使用了由自体或猪心包制成的带瓣心包卷。1例TrV严重反流的婴儿需要进行瓣膜置换并扩大TrV瓣环。1例进行TrV置换的婴儿术后早期死亡。另1例婴儿在完全修复后10个月因外部管道感染死亡。对所有10名幸存者进行了心导管检查。收缩期肺/体循环压力比值的平均值从术前的0.98±0.09降至术后的0.36±0.09。2例儿童和1例婴儿分别在完全修复后10年2个月、7年9个月和1年8个月因管道狭窄进行了外部管道置换。在这2例儿童中的1例，因严重主动脉反流进行了主动脉瓣膜置换。我们得出结论，我们的动脉干完全修复结果令人满意。然而，如何处理合并TrV严重反流的动脉干婴儿仍有待解决。
