Fukumura Y, Kurogami K, Nagano T, Matsuzaki T, Yuasa Y, Kitagawa T, Kato I
Department of Surgery, Tokushima Prefectural Central Hospital.
Kyobu Geka. 1992 Aug;45(9):843-6.
Replacement of the valved extracardiac conduit with autogenous tissue was performed on a 13-year-old female. The procedure was based on that reported by Danielson in 1987. She underwent the first operation for tetralogy of Fallot with pulmonary atresia using a valved extracardiac conduit (#16 mm Björk-Shiley valve) 8 years ago. Recently, she complained exertional dyspnea and chest pain. Reoperation was scheduled because of bleeding tendency, somatic growth of the patient, and severe distal anastomotic stenosis of the conduit by right ventriculogram. At operation, the valved conduit was removed under cardiopulmonary bypass, and autogenous connective tissue around the conduit was preserved as the posterior wall of the new conduit. An onlay patch (pericardial monocusp patch) was sutured to form the roof of the new tract. Postoperative catheterization showed no residual stenosis or pressure gradient between the right ventricle and the pulmonary artery. This technique is useful as the replacement of extracardiac conduit because of its simplicity, no necessity of postoperative anti-coagulant therapy, and possibility to make a generous-sized new outflow tract.
对一名13岁女性患者进行了自体组织置换带瓣心外管道的手术。该手术基于丹尼尔森1987年报告的方法。8年前，她因肺动脉闭锁的法洛四联症接受了首次手术，使用了带瓣心外管道（16毫米的比约克-希利瓣膜）。最近，她抱怨活动后呼吸困难和胸痛。由于出血倾向、患者身体生长以及右心室造影显示管道远端吻合口严重狭窄，因此安排了再次手术。手术中，在体外循环下移除带瓣管道，并保留管道周围的自体结缔组织作为新管道的后壁。缝合一块覆盖补片（心包单瓣补片）以形成新通道的顶部。术后导管检查显示右心室和肺动脉之间无残余狭窄或压力阶差。由于该技术操作简单、术后无需抗凝治疗且有可能构建宽大的新流出道，因此可用于心外管道置换。
