Mavroudis Constantine, Mavroudis Constantine D, Frost Jennifer
Johns Hopkins Children's Heart Surgery, Florida Hospital for Children, Orlando, FL, USA.
World J Pediatr Congenit Heart Surg. 2013 Oct;4(4):422-6. doi: 10.1177/2150135113505296.
Methods to repair tetralogy of Fallot have evolved from large ventriculotomy, large transannular patch placement techniques to smaller, transatrial approaches with valve-sparing strategies in select patients. Despite these advances, there continue to be patients in whom transannular patch is inevitable, and the management of the resulting pulmonary insufficiency that develops from this has been the source of considerable discussion. Techniques aimed at restoring pulmonary valve competence utilizing the remaining valve leaflets after transannular patch placement have recently been proposed for very select patient populations. We review the technical aspects of the operation including removal of the transannular patch and bicuspidization of a formerly tricuspid pulmonary valve, which results in a competent, nonstenotic valve. This report confirms the feasibility of these operative details and highlights the importance of planning before initial repair of tetralogy of Fallot as a way to prepare for a future valve restoration procedure and therefore avoid prosthetic valve placement.
法洛四联症的修复方法已从大型心室切开术、大型跨环补片置入技术发展为在特定患者中采用较小的经心房入路及保留瓣膜策略。尽管有这些进展，但仍有患者不可避免地需要使用跨环补片，由此产生的肺动脉瓣关闭不全的处理一直是大量讨论的焦点。最近针对非常特定的患者群体提出了一些技术，旨在利用跨环补片置入后剩余的瓣膜小叶恢复肺动脉瓣功能。我们回顾了该手术的技术细节，包括移除跨环补片以及将原本的三尖瓣肺动脉瓣二瓣化，从而形成一个功能正常、无狭窄的瓣膜。本报告证实了这些手术细节的可行性，并强调了在法洛四联症初次修复前进行规划的重要性，以此为未来的瓣膜修复手术做准备，从而避免置入人工瓣膜。
