Ajiki H, Nakamura M, Baba M, Nakakura H, Takeda H, Asai Y, Komatsu S, Tomita H, Sawada Y
Department of Surgery (Section 2), Sapporo Medical College, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1991 Jul;39(7):1049-54.
Our surgical experience involving pulmonary atresia with intact ventricular septum (PPA) between the years 1981 and 1989 is reviewed. Twelve infants aged 3 days to 11 months were studied for right ventricular growth potential with angiocardiography and hemodynamics after transventricular pulmonary valvotomy (TVPV). Ten infants were divided into two groups, 5 infants (Group I) were treated with TVPV only, and the other 5 infants (Group II) required additional surgery after the initial operation (TVPV in 2 cases and TVPV with shunt in 3 cases). Post-operative RV growth potential was evaluated with right ventricular index (RVI) based on the tricuspid valve annulus, right ventricular inlet, and right ventricular outlet dimensions, and with tricuspid annular index (TVI) based on the tricuspid valve annulus normalized by aortic diameter. Follow-up (3-69 months after initial operation) studies demonstrated that the RV cavity increased in Group I (RVI of 15.75 +/- 2.92 preoperatively versus 17.00 +/- 1.57 postoperatively, TVI of 3.04 +/- 0.63 versus 3.85 +/- 0.40). In contrast, the RV cavity in Group II demonstrated a lack of growth (RVI of 9.24 +/- 2.60 versus 9.85 +/- 2.76, TVI of 1.46 +/- 0.46 versus 1.70 +/- 0.80). PPA infants with RVI greater than 11 have been treated successfully with TVPV alone, which may maximize the potential for RV growth, but infants with RVI less than 11 have not experienced RV growth + postoperatively and, therefore, have required second intracardiac operations.
回顾了我们在1981年至1989年间对室间隔完整的肺动脉闭锁（PPA）的手术经验。对12例年龄在3天至11个月的婴儿进行了经心室肺动脉瓣切开术（TVPV）后，通过心血管造影和血流动力学研究右心室生长潜能。10例婴儿分为两组，5例婴儿（I组）仅接受TVPV治疗，另外5例婴儿（II组）在初次手术后需要额外手术（2例为TVPV，3例为TVPV加分流术）。术后通过基于三尖瓣环、右心室流入道和右心室流出道尺寸的右心室指数（RVI）以及基于经主动脉直径标准化的三尖瓣环的三尖瓣环指数（TVI）评估右心室生长潜能。随访（初次手术后3 - 69个月）研究表明，I组右心室腔增大（术前RVI为15.75±2.92，术后为17.00±1.57；术前TVI为3.04±0.63，术后为3.85±0.40）。相比之下，II组右心室腔未显示生长（术前RVI为9.24±2.60，术后为9.85±2.76；术前TVI为1.46±0.46，术后为1.70±0.80）。RVI大于11的PPA婴儿仅通过TVPV治疗成功，这可能使右心室生长潜能最大化，但RVI小于11的婴儿术后右心室未生长，因此需要进行二次心脏内手术。
