Staudte K L, Gibson N R, Read R A, Edwards G A
Murdoch University Veterinary Hospital, South St, Murdoch WA 6150.
Aust Vet J. 2004 Jan-Feb;82(1-2):33-7. doi: 10.1111/j.1751-0813.2004.tb14634.x.
Closed pericardial patch-grafting has been advocated for the treatment of severe pulmonic stenosis. In this study pre- and postoperative echocardiography was used to determine if the transvalvular pressure gradient was successfully lowered by this surgery and whether it remained lowered long term. The valvulotomy-ventriculectomy wire was passed using a blunt needle in four dogs (Bresnock technique1) and via a soft catheter in five dogs (Shores and Weirich modification). Eight of nine patients survived the perioperative period. These dogs were assessed up to 40 months following surgery for clinical and echocardiographic changes. Five cases showed significant decrease in peak pulmonic pressure gradient immediately after surgery (decreasing by 50-81%, P < 0.05), and six cases showed significant decrease 2 to 40 months postoperatively (decreasing by 31-80%, P < 0.005) when compared to preoperative values. There was no significant change in pulmonic pressure gradient from immediately postoperatively to 2 to 40 months postoperatively (P < 0.48). Six dogs showed clinical improvement postoperatively, however persistent right ventricular hypertrophy was observed in all cases. One dog died with symptoms of congestive heart failure 16 months postoperatively. Closed pericardial patch grafting can improve clinical signs in symptomatic patients, however the surgery has significant risks, long term prognosis for these patients is guarded and recurrence of clinical signs and development of congestive heart failure is possible. Cardiac changes can be monitored with Doppler flow echocardiography. Patients with extremely elevated preoperative pressure gradients may be expected to have poorer outcomes.
闭合性心包补片移植术已被提倡用于治疗重度肺动脉狭窄。在本研究中，术前和术后超声心动图被用于确定该手术是否成功降低了跨瓣膜压力梯度，以及这种降低是否能长期维持。在4只狗中使用钝针（布雷斯诺克技术1）通过瓣膜切开 - 心室切除术钢丝，在5只狗中通过软导管（肖尔斯和韦里希改良法）。9只动物中有8只在围手术期存活。对这些狗在术后长达40个月的时间里进行临床和超声心动图变化评估。与术前值相比，5例在术后即刻显示肺动脉压力梯度峰值显著降低（降低50 - 81%，P < 0.05），6例在术后2至40个月显示显著降低（降低31 - 80%，P < 0.005）。从术后即刻到术后2至40个月，肺动脉压力梯度没有显著变化（P < 0.48）。6只狗术后临床症状改善，然而所有病例均观察到持续性右心室肥厚。1只狗在术后16个月死于充血性心力衰竭症状。闭合性心包补片移植术可改善有症状患者的临床体征，然而该手术有重大风险，这些患者的长期预后不乐观，临床体征复发和充血性心力衰竭的发生是可能的。心脏变化可用多普勒血流超声心动图监测。术前压力梯度极高的患者可能预后较差。
