Wen Shusheng, Cen Jianzheng, Chen Jimei, Xu Gang, He Biaochuan, Teng Yun, Zhuang Jian
Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China.
J Thorac Dis. 2016 Nov;8(11):3301-3306. doi: 10.21037/jtd.2016.11.43.
In the patients with longer-segment aortic arch hypoplasia or interruption with ventricular septal defect, surgery with homograft vessel or autologous pericardial patch to augment descending aortic arch will not result in adverse reactions caused by end-to-end anastomosis. In this study, we retrospectively analyzed primary experience of surgical correction of complicated aortic arch anomaly with autologous main pulmonary artery.
From July 2010 to March 2016, the twenty-one cases of aortic arch complex anomalies were reconstructed with autologous main pulmonary artery. There were 5 patients with interrupted aortic arch and 16 patients with coarctation of aorta. In patients with interrupted aortic arch, anterior wall of main pulmonary artery was excised to form a conduit whose diameter varied according to the area of patient's body surface. Both ends of the conduit were anastomosed to aortic arch and descending aorta, respectively. In other patients with coarctation of aorta, aortic arch was augmented with tailored pulmonary artery patch in oval shape. The defect of main pulmonary artery was repaired with autologous pericardial patch.
There was only one patient died of multiple organ failure postoperatively. The other twenty patients survived without any neurologic complications. Differences of blood pressure between upper and lower limbs were not significant in all cases. During follow-up period, the echocardiography for all patients in the third, sixth, twelfth, and twenty-fourth months showed that blood flow in the descending aortic arch was fluent and there was no obvious blood pressure gradient.
Autologous main pulmonary artery can be used to repair complicated aortic arch anomalies completely without any anastomotic tension or bronchial obstruction postoperatively. This procedure is feasible and possesses predominant early and mid-term effects, and autologous main pulmonary artery can retain growth capacity during follow-up period. Of course, it is necessary to draw a definite conclusion of this technique during long-term follow-up period.
在患有较长节段主动脉弓发育不全或中断并伴有室间隔缺损的患者中，使用同种异体血管或自体心包补片进行手术以扩大降主动脉弓不会导致端端吻合引起的不良反应。在本研究中，我们回顾性分析了使用自体主肺动脉手术矫正复杂主动脉弓异常的初步经验。
2010年7月至2016年3月，对21例主动脉弓复杂异常患者采用自体主肺动脉进行重建。其中主动脉弓中断5例，主动脉缩窄16例。对于主动脉弓中断的患者，切除主肺动脉前壁以形成一个导管，其直径根据患者体表面积而变化。导管的两端分别与主动脉弓和降主动脉吻合。对于其他主动脉缩窄患者，用定制的椭圆形肺动脉补片扩大主动脉弓。主肺动脉缺损用自体心包补片修复。
仅1例患者术后死于多器官功能衰竭。其他20例患者存活，无任何神经系统并发症。所有病例上下肢血压差异均不显著。随访期间，对所有患者在第3、6、12和24个月进行超声心动图检查，结果显示降主动脉弓血流通畅，无明显血压梯度。
自体主肺动脉可用于完全修复复杂的主动脉弓异常，术后无任何吻合口张力或支气管梗阻。该手术可行，具有良好的早期和中期效果，自体主肺动脉在随访期间可保留生长能力。当然，有必要在长期随访期间对该技术得出明确结论。
