Department of Cardiac Surgery, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
Ann Thorac Surg. 2011 Feb;91(2):555-60. doi: 10.1016/j.athoracsur.2010.09.024.
Pulmonary valve replacement (PVR) is a common therapy for chronic pulmonary regurgitation. However, the use of this strategy is mostly based on the studies performed on patients with tetralogy of Fallot (TOF) and not in patients with pulmonary atresia/intact ventricular septum (PA/IVS). The aim of this study is to evaluate our experience with PVR in patients with PA/IVS and compare them with a matched cohort of TOF patients.
Between 1995 and 2009, 13 patients with PA/IVS underwent a late PVR. Matched TOF control subjects were identified for 12 of these patients. Before and after PVR echocardiographic, magnetic resonance imaging, exercise test, Holter, and electrocardiographic data were compared between groups.
There was no mortality in either group. The PVR improved pulmonary regurgitant fraction and right ventricular volumes in all patients. Patients with PA/IVS had more significant tricuspid regurgitation (TR [at least moderate]) by echocardiography and magnetic resonance imaging before PVR (n = 11 [85%] versus n = 1 [8%]; p = 0.003) and had more tricuspid valve repairs than TOF patients (n = 9 [69%] versus n = 1 [8%]; p = 0.004). Repair was undertaken by a combination of techniques. Although TR was improved early postoperatively, only 2 of 9 patients (22%) were free from significant TR at most recent follow-up (median 2.5 years; range, 0.1 to 10.9). No patient underwent reoperation at latest follow-up.
Patients with PA/IVS can undergo a late PVR with excellent results. Significant TR and repair are more commonly observed among patients with PA/IVS compared with TOF patients. Although tricuspid valve repair improves regurgitation early, TR tends to recur, suggesting the need for further refinement of current surgical techniques.
肺动脉瓣置换术（PVR）是治疗慢性肺动脉瓣反流的常用方法。然而，该策略的应用主要基于法洛四联症（TOF）患者的研究，而不是在肺动脉瓣闭锁/室间隔完整（PA/IVS）患者中。本研究旨在评估我们在 PA/IVS 患者中进行 PVR 的经验，并将其与 TOF 患者的匹配队列进行比较。
1995 年至 2009 年间，13 例 PA/IVS 患者接受了晚期 PVR。其中 12 例患者匹配了 TOF 对照组。比较两组患者 PVR 前后的超声心动图、磁共振成像、运动试验、动态心电图和心电图数据。
两组均无死亡病例。所有患者的 PVR 均改善了肺动脉瓣反流分数和右心室容量。PA/IVS 患者在 PVR 前的超声心动图和磁共振成像上有更多的三尖瓣反流（TR [至少中度]）（n = 11 [85%] 比 n = 1 [8%]；p = 0.003），并且比 TOF 患者有更多的三尖瓣修复术（n = 9 [69%] 比 n = 1 [8%]；p = 0.004）。修复采用了多种技术。尽管术后早期 TR 得到改善，但在最近的随访中，只有 9 例患者中的 2 例（22%）没有明显的 TR（中位数 2.5 年；范围 0.1 至 10.9 年）。在最新随访时，没有患者再次手术。
PA/IVS 患者可以进行晚期 PVR，效果良好。PA/IVS 患者比 TOF 患者更常出现严重的 TR 和修复。尽管三尖瓣修复术早期改善了反流，但 TR 往往会复发，这表明需要进一步改进目前的手术技术。
