Pediatric Heart Center, Fuwai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing 10037, People's Republic of China.
Eur J Cardiothorac Surg. 2011 Nov;40(5):1221-6. doi: 10.1016/j.ejcts.2011.02.035. Epub 2011 Mar 31.
To assess the operative and mid-term outcome of a very aggressive pulmonary annulus preservation strategy and pulmonary valve leaflet plasty technique which achieved 95% freedom of transannular patch (TAP) in complete tetralogy repair.
From August 2006 through May 2010, 139 consecutive patients underwent repair of tetralogy of Fallot at a median age of 6.5 months, with median weight 7.2kg. None of the patients had a prior shunt. A total of 132 patients (95%) had pulmonary valve annulus-sparing procedures, predominantly through a transatrial and transpulmonary approach (n=120%, 86.3%). Special techniques included generous pulmonary supra-valve patch, bicuspid pulmonary leaflets plasty, or augmentation to maximally preserve pulmonary annulus. All the patients who survived were followed up closely.
Only seven (5.0%) patients had a TAP. Among them, five (71.4%) had doubly committed subarterial defect. None of the tricuspid pulmonary valves need TAP. Preoperative size of pulmonary annulus<-6 is associated with TAP (p<0.001). A total of 12 (13.7%) patients needed repump to do either a ventriculotomy and patch the incision or a TAP to relieve residual stenosis. One patient needed a third pump run to do a TAP. The operative mortality was 0.7%, and there was one late death due to hemoptysis. The pulmonary regurgitation of non-TAP patients was less than mild in 105 (79.5%) and mild to moderate in 27 (20.5%) patients. Three patients had peak gradient greater than 50mmHg across the right ventricle and pulmonary artery at 1-month follow-up, but the gradient dropped to less than 50mmHg in two patients at 6-month follow-up. One patient had a persistent 50-55mmHg gradient across pulmonary valve and he is under close follow-up.
Excellent outcome can be achieved even with 95% freedom of TAP in complete repair of tetralogy. The function of most patients' pulmonary valve was well preserved.
评估一种非常激进的肺动脉瓣环保留策略和肺动脉瓣叶成形技术的手术和中期结果，该策略在完全法洛四联症修复中实现了 95%的跨瓣环补片（TAP）自由。
2006 年 8 月至 2010 年 5 月，139 例连续法洛四联症患者在中位年龄 6.5 个月、中位体重 7.2kg 时接受修复。所有患者均未进行过分流术。共有 132 例（95%）患者行肺动脉瓣环保留术，主要通过经心房和经肺途径（n=120%，86.3%）。特殊技术包括充分的肺动脉瓣上补片、二瓣化肺动脉瓣叶成形术或增加术以最大限度地保留肺动脉瓣环。所有存活患者均密切随访。
仅 7 例（5.0%）患者有 TAP。其中，5 例（71.4%）有双重亚室间隔缺损。所有三尖瓣肺动脉瓣均无需 TAP。术前肺动脉瓣环<6 与 TAP 相关（p<0.001）。共有 12 例（13.7%）患者需要再次泵入以进行心室切开和修补切口或 TAP 以缓解残余狭窄。1 例患者需要第三次泵入以进行 TAP。手术死亡率为 0.7%，有 1 例患者因咯血死亡。非 TAP 患者的肺动脉瓣反流在 105 例（79.5%）患者中小于轻度，在 27 例（20.5%）患者中为轻度至中度。3 例患者在 1 个月随访时右心室和肺动脉之间的峰值梯度大于 50mmHg，但其中 2 例在 6 个月随访时梯度降至 50mmHg 以下。1 例患者的肺动脉瓣仍有 50-55mmHg 的梯度，目前正在密切随访中。
即使在完全法洛四联症修复中实现 95%的 TAP 自由，也能取得极佳的结果。大多数患者的肺动脉瓣功能得到了很好的保留。
