Wu Ming, Yang Jinfu, Yang Yifeng, Hu Jianguo, Zhou Xinmin, Liu Feng, Wu Zhongshi, Zhao Tianli, Xiong Lian, Wang Xin, Yin Ni
Department of Cardiothoracic Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2011 Nov;36(11):1097-101. doi: 10.3969/j.issn.1672-7347.2011.11.011.
To explore the effect of unidirectional valved patch (UVP) for congenital heart disease (CHD) with severe pulmonary hypertension (PH).
We retrospectively analyzed the treatment of 37 CHD patients with severe PH by UVP in the operation, and summarized its short-term to mid-term effect to find an optimum therapeutic regimen.
Before the operation, the ECG showed that the mean pulmonary artery pressure (MPAP) ranged 65-72 mmHg, and the cardiac catheterization showed the pulmonary artery pressure ranged 80-120 mmHg, P(P)/P(A) ranged 0.8-1.05,PVR ranged 8.5-19.2 (under oxygen inhalation 6.8-14.6) wood unit.After the operation, P(P)/P(A) ranged 0.4-0.72 on weaning-off CPB. Postoperative ECG showed the MPAP ranged 32-48 mmHg. No pulmonary hypertension crisis occurred and no patient died. Mechanical ventilation time ranged from 32 h to 8 d and the SaO₂ ranged 93%-96% at rest after the extubation.The right-to-left shunt situations by ECG were as follows:22 cases had shunt 5 d after the operation, 11 cases had shunt 1 month after the operation,4 cases 3 months after the operation, and none 1 year after the operation but one patient lost follow-up.However,there were no long-term follow-up data: 12 patients had a 1-year follow-up, 5 patients had a 3-year follow-up, and most patients had just 3-month follow-up.
UVP can decrease the operative risk in CHD with severe PH at perioperative period. The short-term to mid-term effect is satisfactory, while long-term effect remains uncertain.
探讨单向带瓣补片（UVP）治疗先天性心脏病（CHD）合并重度肺动脉高压（PH）的效果。
回顾性分析37例CHD合并重度PH患者手术中采用UVP治疗的情况，总结其短期至中期效果，以寻找最佳治疗方案。
术前心电图显示平均肺动脉压（MPAP）为65 - 72 mmHg，心导管检查显示肺动脉压为80 - 120 mmHg，P（P）/P（A）为0.8 - 1.05，肺血管阻力（PVR）为8.5 - 19.2（吸氧时为6.8 - 14.6）wood单位。术后停机时P（P）/P（A）为0.4 - 0.72。术后心电图显示MPAP为32 - 48 mmHg。未发生肺动脉高压危象，无患者死亡。机械通气时间为32小时至8天，拔管后静息时血氧饱和度（SaO₂）为93% - 96%。心电图显示的右向左分流情况如下：术后5天有分流者22例，术后1个月有分流者11例，术后3个月有分流者4例，术后1年除1例失访外均无分流。然而，无长期随访数据：12例患者进行了1年随访，5例患者进行了3年随访，大多数患者仅进行了3个月随访。
UVP可降低CHD合并重度PH围手术期的手术风险。短期至中期效果满意，但长期效果仍不确定。
