del Nido Pedro J
Department of Cardiac Surgery, Children's Hospital - Boston, Harvard Medical School, Boston, MA 02115, USA.
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2006:29-34. doi: 10.1053/j.pcsu.2006.02.007.
With the increasing number of late survivors of repair of tetralogy of Fallot, surgical management of patients with right ventricular (RV) dysfunction and limited exercise capacity has become a more frequent problem. The wide variability in clinical status, extent of RV dilatation, and dysfunction at the time of presentation for surgical intervention has resulted in disparate surgical results after pulmonary valve insertion. With increasing use of magnetic resonance imaging, quantitative measures of RV volumes, function, and pulmonary regurgitant fraction have enabled a more systematic analysis of results. While there is a group of patients that responds favorably to pulmonary valve insertion, there is also a large subgroup that does not; this requires further analysis of the mechanisms responsible. We have developed a surgical approach to this latter group of patients, which incorporates the concepts of ventricular remodeling or restoration developed for the left ventricle following myocardial infarction. Preliminary results indicate that this procedure is equally safe to pulmonary valve insertion alone, and may result in improved RV function.
随着法洛四联症修复术后晚期存活者数量的增加，右心室（RV）功能障碍且运动能力受限患者的外科治疗已成为一个更为常见的问题。手术干预时临床状况、RV扩张程度和功能障碍的广泛差异导致肺动脉瓣植入术后手术结果参差不齐。随着磁共振成像的使用增加，RV容积、功能和肺反流分数的定量测量使得对结果进行更系统的分析成为可能。虽然有一组患者对肺动脉瓣植入反应良好，但也有很大一部分亚组患者并非如此；这需要进一步分析其背后的机制。我们已为后一组患者开发了一种手术方法，该方法纳入了心肌梗死后为左心室开发的心室重塑或恢复的概念。初步结果表明，该手术与单独进行肺动脉瓣植入同样安全，并且可能改善RV功能。
