Ninet J, Vigneron M, Curtil A, Rizk M, Bozio A, Champsaur G
Service de chirurgie thoracique et cardio-vasculaire, hôpital cardiologique, BP Lyon Montchat.
Arch Mal Coeur Vaiss. 1990 May;83(5):707-10.
Seven children or adolescents aged 8 to 20 years (average 13.5 years) underwent implantation of an apico-aortic conduit from 1980 to June 1989. Eleven previous operations under cardiopulmonary bypass had been performed. The indications were recurrence of muscular subaortic stenosis and/or congenital valvular stenosis in 3 cases, and stenotic, previously implanted aortic valve prosthesis of small calibre in 4 cases. The preoperative left ventricular-aortic systolic pressure gradient was between 70 and 130 mmHg. The first two patients had a bioprosthetic valvulation and the 5 succeeding patients a St Jude Medical mechanical prosthesis. The early and late mortality was nil. The average follow-up period is 5, 6 years at present (range 6 months to 9 years). One patient had to undergo repeat valve replacement after 5 years for degenerescence of the porcine bioprosthesis implanted in the conduit. No other complications related to the conduit or valve were observed. At the endpoint of the study all patients were asymptomatic without treatment. Control echocardiographic data showed normalisation of the indices of left ventricular function. Apico-aortic conduits would seem to be a safe and effective technique for the treatment of recurrent severe obstruction of the left ventricular outflow tract.
1980年至1989年6月期间，7名年龄在8至20岁（平均13.5岁）的儿童或青少年接受了心尖 - 主动脉管道植入术。此前已在体外循环下进行了11次手术。手术指征为：3例为肌性主动脉瓣下狭窄和/或先天性瓣膜狭窄复发，4例为口径小的狭窄性、先前植入的主动脉瓣膜假体。术前左心室 - 主动脉收缩压梯度在70至130 mmHg之间。前两名患者进行了生物瓣膜置换，随后的5名患者植入了圣犹达医疗机械瓣膜。早期和晚期死亡率为零。目前平均随访期为5.6年（范围6个月至9年）。一名患者在5年后因植入管道中的猪生物瓣膜退变而不得不再次进行瓣膜置换。未观察到与管道或瓣膜相关的其他并发症。在研究终点，所有患者未经治疗均无症状。对照超声心动图数据显示左心室功能指标恢复正常。心尖 - 主动脉管道似乎是治疗左心室流出道复发性严重梗阻的一种安全有效的技术。
