Department of Cardiology, Children's Hospital, Boston, MA, USA.
J Thorac Cardiovasc Surg. 2011 Dec;142(6):1367-73. doi: 10.1016/j.jtcvs.2011.02.047. Epub 2011 Jun 24.
The late morbidity of pulmonary regurgitation has intensified the interest in valve-sparing repair of tetralogy of Fallot. This study reviewed a single institution's experience with valve-sparing repair and investigated the role of intraoperative balloon valvuloplasty.
A retrospective chart review identified 238 patients who underwent complete primary repair of tetralogy of Fallot at less than 180 days of age. Patients were divided into 4 groups on the basis of the type of right ventricular outflow tract repair: transannular patch (n = 111), commissurotomy or standard rigid dilation (n = 71), intraoperative balloon pulmonary valvuloplasty (n = 32), or no valvar intervention (n = 24).
Baseline demographic and anatomic factors differed among the 4 procedural groups with substantial overlap. Among 142 patients with pulmonary valve hypoplasia (z score, -2 to -4), 37% had valve-sparing repair. These patients had significant annular growth over time: z score increased 0.67 and 1.00 per year in the intraoperative balloon valvuloplasty (P < .001) and traditional valve-sparing (P < .001) groups, respectively. Rates of valve growth did not differ across groups, but z scores were 0.58 lower for the balloon valvuloplasty group across all time points (P = .001). Freedom from reintervention and surgery was shorter for the balloon valvuloplasty group than for the other groups (P < .001).
Patients with tetralogy of Fallot and pulmonary valve hypoplasia who undergo valve-sparing repair with intraoperative balloon valvuloplasty have significant longitudinal annular growth, with normalization of annular size over time. Despite application in patients with more hypoplastic valves, balloon valvuloplasty resulted in similar valve growth and pulmonary regurgitation as traditional methods, but higher rates of reintervention. Although the precise role of this technique needs further refinement, it is likely to be most useful in patients with moderate pulmonary stenosis and moderate pulmonary valve dysplasia.
肺动脉瓣反流的晚期发病率增加了人们对法洛四联症保留瓣膜修复的兴趣。本研究回顾了单中心的保留瓣膜修复经验，并探讨了术中球囊瓣膜成形术的作用。
回顾性图表分析确定了 238 名在 180 天龄以下接受法洛四联症完全一期修复的患者。根据右心室流出道修复类型，将患者分为 4 组：瓣环补片（n=111）、交界切开术或标准硬性扩张（n=71）、术中球囊肺动脉瓣成形术（n=32）或无瓣膜干预（n=24）。
4 个手术组的基线人口统计学和解剖因素不同，但存在大量重叠。在 142 名肺动脉瓣发育不全（z 评分-2 至-4）的患者中，37%行保留瓣膜修复。这些患者的瓣环有显著的生长：术中球囊成形术（P<.001）和传统保留瓣膜修复（P<.001）组的 z 评分每年分别增加 0.67 和 1.00。各组之间的瓣膜生长速度没有差异，但球囊成形术组在所有时间点的 z 评分均低 0.58（P=.001）。球囊成形术组的再次干预和手术率较其他组短（P<.001）。
接受术中球囊瓣膜成形术保留瓣膜修复的法洛四联症伴肺动脉瓣发育不全患者有明显的纵向瓣环生长，随着时间的推移，瓣环大小逐渐正常化。尽管球囊成形术应用于更多发育不良的瓣膜患者，但与传统方法相比，球囊成形术导致的瓣膜生长和肺动脉反流相似，但再干预率更高。尽管该技术的精确作用需要进一步完善，但它可能对中重度肺动脉狭窄和中度肺动脉瓣发育不良的患者最有用。
