Morales David L S, Braud Brandi E, DiBardino Daniel J, Carberry Kathleen E, McKenzie E Dean, Heinle Jeffrey S, Fraser Charles D
Michael E. DeBakey Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
Congenit Heart Dis. 2007 Mar-Apr;2(2):115-20. doi: 10.1111/j.1747-0803.2007.00083.x.
No ideal option exists for restoring pulmonary valve competence late after repair of the congenitally abnormal right ventricular outflow tract (RVOT). This has driven a continued search for new alternatives. Texas Children's Hospital has recently used the Carpentier-Edwards Perimount RSR Pericardial Aortic Prosthesis (Edwards Lifesciences, Irvine, Calif, USA) for this indication and reports the initial experience.
Retrospective chart review.
Academically affiliated tertiary-care pediatric hospital.
Twenty-six patients who underwent pulmonary valve replacement with the Perimount valve late after RVOT reconstruction between June 2002 and November 2005.
No prospective interventions.
Hospital morbidity and mortality. Valve function assessed by follow-up visits and echocardiograms.
Mean age and weight of the patients were 20.3 +/- 9.8 years (range 7.0-45.1 years) and 56.2 +/- 18.1 kg (range 35.8-109 kg). Twenty-two patients (85%) had severe pulmonary insufficiency (PI), 23 (89%) had symptomatic right heart failure, and 14 (54%) had moderate to severe right ventricular dysfunction. Average prosthetic valve size was 23 mm (range 19-27 mm). Twenty-one (88%) patients were extubated within 24 hours. There was no hospital mortality. Median length of stay for all patients from day of surgery was 6 days (range 3-56 days). Median length of last echocardiography follow-up was 12.4 months (range 0.1-37.6 months). At that time, 16 of the 26 (62%) patients had improved right ventricular function, no patient demonstrated significant RVOT obstruction, and 24 patients (92%) have no PI or mild PI. Freedom from death, reintervention, or reoperation on the pulmonary valve is 100% at 2.5 years.
Initial results with the Perimount bovine pericardial tissue prosthesis for pulmonary valve replacement are encouraging. Further follow-up is required to define long-term function and durability.
对于先天性异常右心室流出道（RVOT）修复术后晚期恢复肺动脉瓣功能，目前尚无理想的选择。这促使人们持续寻找新的替代方案。德克萨斯儿童医院最近已将Carpentier-Edwards Perimount RSR心包主动脉瓣膜（美国加利福尼亚州尔湾市爱德华兹生命科学公司）用于这一适应证，并报告了初步经验。
回顾性病历审查。
一所大学附属医院的三级儿科医院。
2002年6月至2005年11月期间在RVOT重建术后晚期接受Perimount瓣膜肺动脉瓣置换术的26例患者。
无前瞻性干预措施。
医院发病率和死亡率。通过随访和超声心动图评估瓣膜功能。
患者的平均年龄和体重分别为20.3±9.8岁（范围7.0 - 45.1岁）和56.2±18.1 kg（范围35.8 - 109 kg）。22例患者（85%）有严重肺动脉瓣关闭不全（PI），23例（89%）有症状性右心衰竭，14例（54%）有中度至重度右心室功能障碍。人工瓣膜平均尺寸为23 mm（范围19 - 27 mm）。21例（88%）患者在24小时内拔管。无医院死亡病例。所有患者从手术日起的中位住院时间为6天（范围3 - 56天）。最后一次超声心动图随访的中位时间为12.4个月（范围0.1 - 37.6个月）。此时，26例患者中有16例（62%）右心室功能改善，无患者出现明显的RVOT梗阻，24例患者（92%）无PI或仅有轻度PI。在2.5年时，肺动脉瓣免于死亡、再次干预或再次手术的比例为100%。
Perimount牛心包组织瓣膜用于肺动脉瓣置换术的初步结果令人鼓舞。需要进一步随访以确定其长期功能和耐久性。
