Vida Vladimiro L, Angelini Annalisa, Guariento Alvise, Frescura Carla, Fedrigo Marni, Padalino Massimo, Sanders Stephen P, Thiene Gaetano, Stellin Giovanni
Pediatric and Congenital Cardiac Surgery Unit, Department of Thoracic, Cardiac and Vascular Sciences, University of Padua, Padua, Italy.
Cardiovascular Pathology Unit, Department of Thoracic, Cardiac and Vascular Sciences, University of Padua, Padua, Italy.
J Thorac Cardiovasc Surg. 2015 May;149(5):1358-63.e1. doi: 10.1016/j.jtcvs.2015.01.030. Epub 2015 Jan 21.
To describe the anatomy of the PV in tetralogy of Fallot (TOF) and to define the influence of PV anatomy on the development of surgical techniques for PV preservation during early repair.
The PV was evaluated in 79 anatomic specimens of patients with TOF who had not undergone surgery for repair, and in 82 patients who underwent early TOF repair at our institution. New surgical techniques for PV preservation during early repair are described.
The PV in TOF was predominantly bicuspid (n = 118 of 160; 73.7%), less frequently tricuspid (n = 28 of 160; 17.5%), and seldom unicuspid (n = 14 of 160; 8.8%). In 82 cases (51.3%), the PV cusps were normal; in 78 cases (48.7%), they were thickened and dysplastic. Preservation of the PV was possible in 46 of 82 (56%) consecutive patients during TOF repair in our more recent experience, either using balloon dilation alone (18 of 46; 39%) or in association with other PV plasty procedures (28 of 46; 61%). Most bicuspid and tricuspid valves were salvageable, but unicuspid valves were not suitable. After a median follow-up time of 2.8 years (range, 0.5-6.8 years), the degree of PV regurgitation continued to be zero or mild in 40 patients (86%), and moderate in 6 (14%).
The majority of patients with TOF (>90%) have a bicuspid or tricuspid PV, which is the most favorable surgical anatomy for preserving the PV, independent of the degree of leaflet dysplasia. The recent introduction of more-complex PV plasty techniques, such as delamination plasty, allowed us to further extend the applicability of PV-preservation techniques.
描述法洛四联症（TOF）中肺动脉瓣（PV）的解剖结构，并确定PV解剖结构对早期修复术中PV保留手术技术发展的影响。
对79例未经手术修复的TOF患者的解剖标本以及在我院接受早期TOF修复的82例患者的PV进行评估。描述了早期修复术中PV保留的新手术技术。
TOF中的PV主要为二叶式（160例中的118例；73.7%），三叶式较少见（160例中的28例；17.5%），单叶式罕见（160例中的14例；8.8%）。82例（51.3%）中PV瓣叶正常；78例（48.7%）中瓣叶增厚且发育异常。在我们最近的经验中，82例连续TOF修复患者中有46例（56%）能够保留PV，单独使用球囊扩张术（46例中的18例；39%）或与其他PV成形术联合使用（46例中的28例；61%）。大多数二叶式和三叶式瓣膜可挽救，但单叶式瓣膜不适合。中位随访时间为2.8年（范围0.5 - 6.8年）后，40例患者（86%）的PV反流程度持续为零或轻度，6例（14%）为中度。
大多数TOF患者（>90%）有二叶式或三叶式PV，这是保留PV最有利的手术解剖结构，与瓣叶发育异常程度无关。最近引入的更复杂的PV成形技术，如分层成形术，使我们能够进一步扩大PV保留技术的适用性。
