Anagnostopoulos Petros, Azakie Anthony, Natarajan Shobha, Alphonso Nelson, Brook Michael M, Karl Tom R
Division of Pediatric Cardiac Surgery, Pediatric Heart Center, University of California at San Francisco Children's Hospital, San Francisco, Calif, USA.
J Thorac Cardiovasc Surg. 2007 Mar;133(3):640-7. doi: 10.1016/j.jtcvs.2006.10.039.
The transannular patch used to relieve right ventricular outflow tract obstruction in children with tetralogy of Fallot may result in pulmonary insufficiency. We hypothesized that pulmonary valve cusp augmentation with pericardium would decrease pulmonary insufficiency and improve the early outcome for transatrial-transpulmonary tetralogy of Fallot repair requiring transannular patch.
Since November 2001, 41 patients with tetralogy of Fallot and 2 patients with isolated pulmonary valve stenosis had relief of right ventricular outflow tract obstruction with either a transannular patch plus pulmonary valve cusp augmentation (n = 18) or a transannular patch alone (n = 25). Data were retrospectively collected.
The median age (5.3 vs 3.2 months; P = .09) and weight (6.4 vs 5.2 kg; P = .3) were similar for the cusp augmentation and transannular patch groups, respectively. The diameter of the pulmonary valve annulus (6.4 vs 6.0 mm; P = .57) and the McGoon index (1.47 vs 1.69, P = .75) were also similar. The mean aortic clamp time (48 +/- 18 minutes vs 52 +/- 19 minutes; P = .46) and median cardiopulmonary bypass time (89 vs 91 minutes; P = .9) did not differ. One patient with a transannular patch died of multiorgan system failure. Patients with a pulmonary valve cusp augmentation had a shorter duration of intubation (1 vs 3 days; P < .001) and intensive care unit stay (2 vs 8 days; P < .001). Thirteen patients with a transannular patch and 1 patient with a pulmonary valve cusp augmentation required inotropic support for more than 72 hours (P = .001). Discharge echocardiograms demonstrated moderate or severe pulmonary insufficiency in 5 patients with a pulmonary valve cusp augmentation and in 21 patients with a transannular patch (P < .001). At 7.5 months, 3 patients (17%) with a pulmonary valve cusp augmentation had progression of pulmonary insufficiency.
Augmentation of a pulmonary valve cusp reduces the incidence of clinically significant postoperative pulmonary insufficiency. This technique may improve the early outcome for children with tetralogy of Fallot requiring a transannular patch.
用于缓解法洛四联症患儿右心室流出道梗阻的跨瓣补片可能会导致肺动脉瓣关闭不全。我们推测，用心包对肺动脉瓣叶进行扩大可减少肺动脉瓣关闭不全，并改善需要跨瓣补片的经心房 - 经肺动脉法洛四联症修复术的早期预后。
自2001年11月起，41例法洛四联症患者和2例孤立性肺动脉瓣狭窄患者通过跨瓣补片联合肺动脉瓣叶扩大术（n = 18）或单纯跨瓣补片术（n = 25）缓解了右心室流出道梗阻。数据进行回顾性收集。
瓣叶扩大组和跨瓣补片组的中位年龄（分别为5.3个月和3.2个月；P = 0.09）和体重（分别为6.4 kg和5.2 kg；P = 0.3）相似。肺动脉瓣环直径（分别为6.4 mm和6.0 mm；P = 0.57）和麦戈恩指数（分别为1.47和1.69，P = 0.75）也相似。平均主动脉阻断时间（分别为48 ± 18分钟和52 ± 19分钟；P = 0.46）和中位体外循环时间（分别为89分钟和91分钟；P = 0.9）无差异。1例接受跨瓣补片术的患者死于多器官系统衰竭。接受肺动脉瓣叶扩大术的患者插管时间（分别为1天和3天；P < 0.001）和重症监护病房住院时间（分别为2天和8天；P < 0.001）较短。13例接受跨瓣补片术的患者和1例接受肺动脉瓣叶扩大术的患者需要超过72小时的血管活性药物支持（P = 0.001）。出院时超声心动图显示，5例接受肺动脉瓣叶扩大术的患者和21例接受跨瓣补片术的患者存在中度或重度肺动脉瓣关闭不全（P < 0.001）。在7.5个月时，3例（17%）接受肺动脉瓣叶扩大术的患者出现肺动脉瓣关闭不全进展。
肺动脉瓣叶扩大可降低具有临床意义的术后肺动脉瓣关闭不全的发生率。该技术可能改善需要跨瓣补片的法洛四联症患儿的早期预后。
