Takahashi Yosuke, Tsutsumi Yasushi, Monta Osamu, Kato Yasuyuki, Kohshi Keitaro, Sakamoto Tomohiko, Ohashi Hirokazu, Miyazaki Takako, Yamagishi Masaaki
Department of Cardiovascular Surgery, Fukui Cardiovascular Center, 2-228 Shinbo, Fukui, Fukui 910-0833, Japan.
Gen Thorac Cardiovasc Surg. 2010 Jan;58(1):14-8. doi: 10.1007/s11748-009-0527-9. Epub 2010 Jan 9.
Generally, right ventricular outflow tract reconstruction in adults is performed using homografts or xenograft. However, sufficient graft material is difficult to obtain and has the problems of calcification and structure destruction. We, therefore, evaluated using expanded polytetrafluoroethylene- (ePTFE)-valved conduits with bulging sinuses for right ventricular outflow tract reconstruction in adults.
Between February 2006 and April 2008, a total of five patients (three men, two women), ages 25-51 years old (mean +/- SD, 40 +/- 11 years)] underwent right ventricular outflow tract (RVOT) reconstruction in our institution. In three patients, RVOT reconstruction was performed with the Ross procedure; and in all cases, tricuspid ePTFE (valved conduits with bulging sinuses were used. The diameter of the conduit was determined according to the RVOT size. Valve function was followed up using echocardiography after surgery and during the early/mid-term periods of recovery (13 months to 3.0 years).
No morbidity occurred, and no patient required further surgery during the follow-up period. During these follow-up periods, pulmonary observation revealed that no patients had stenosis; regurgitation was mild in one patient and trivial in four patients. In regard to the tricuspid valve, regurgitation was trivial in four patients and mild in one patient.
Although long-term follow-up is required to confirm the durability of the ePTFE-valved conduit with bulging sinuses, the present results indicate a satisfactory result in patients who undergo RVOT reconstruction, even in adult cases.
一般来说，成人右心室流出道重建采用同种异体移植物或异种移植物。然而，获得足够的移植物材料困难，且存在钙化和结构破坏问题。因此，我们评估了使用带膨出窦的膨体聚四氟乙烯（ePTFE）带瓣管道进行成人右心室流出道重建。
2006年2月至2008年4月，共有5例患者（3例男性，2例女性），年龄25 - 51岁（平均±标准差，40±11岁）在我院接受右心室流出道（RVOT）重建。3例患者采用Ross手术进行RVOT重建；所有病例均使用三尖瓣ePTFE（带膨出窦的带瓣管道）。根据RVOT大小确定管道直径。术后及恢复早期/中期（13个月至3.0年）采用超声心动图随访瓣膜功能。
随访期间无并发症发生，无患者需要再次手术。在这些随访期间，肺部观察显示无患者出现狭窄；1例患者有轻度反流，4例患者有微量反流。关于三尖瓣，4例患者有微量反流，1例患者有轻度反流。
尽管需要长期随访以确认带膨出窦的ePTFE带瓣管道的耐久性，但目前的结果表明，即使在成人病例中，接受RVOT重建的患者也取得了满意的结果。
