Kumar T K Susheel, Briceno-Medina Mario, Sathanandam Shyam, Joshi Vijaya M, Knott-Craig Christopher J
Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tennessee.
Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tennessee.
Ann Thorac Surg. 2017 Jun;103(6):1969-1974. doi: 10.1016/j.athoracsur.2016.11.078. Epub 2017 Mar 3.
The polytetrafluoroethylene tube used as right ventricle to pulmonary artery conduit in the stage 1 Norwood operation is associated with risks of suboptimal branch pulmonary artery growth, thrombosis, free insufficiency, and long-term right ventricular dysfunction. Our experience with use of valved femoral vein homograft as right ventricle to pulmonary artery conduit is described.
Between June 2012 and December 2015, 15 neonates with hypoplastic left heart syndrome or complex single ventricle underwent stage 1 Norwood operation with valved segment of femoral vein homograft as right ventricle to pulmonary artery conduit. The median age at surgery was 3 days and the mean weight was 3 kg. The size of the femoral vein homograft was 5 mm in 8 patients and 6 mm in 7 patients.
There was no hospital or interstage mortality. Fourteen patients underwent Glenn operation, and 6 have undergone Fontan operation to date. The median Nakata index at pre-Glenn catheterization was 262 mm/m (interquartile range: 121 to 422 mm/m). No patient had thrombosis of conduit. Most femoral vein conduits remained competent in the first month after stage 1 Norwood operation, although most became incompetent by 3 months. Catheter intervention on the conduit was necessary in 7 patients. Right ventricular function was preserved in most patients at follow-up.
The use of femoral vein homograft as right ventricle to pulmonary artery conduit in the Norwood operation is safe and associated with good pulmonary artery growth and preserved ventricular function. Balloon dilation of the conduit may be necessary during the interstage period.
在一期诺伍德手术中用作右心室至肺动脉管道的聚四氟乙烯管与肺动脉分支发育欠佳、血栓形成、瓣膜关闭不全及长期右心室功能障碍的风险相关。本文描述了我们使用带瓣股静脉同种异体移植物作为右心室至肺动脉管道的经验。
2012年6月至2015年12月期间，15例左心发育不全综合征或复杂单心室新生儿接受了一期诺伍德手术，使用带瓣股静脉同种异体移植物作为右心室至肺动脉管道。手术时的中位年龄为3天，平均体重为3千克。8例患者的股静脉同种异体移植物尺寸为5毫米，7例患者为6毫米。
无院内或过渡期死亡。14例患者接受了格林手术，迄今为止6例患者接受了Fontan手术。格林手术前导管插入术时的中位中田指数为262 mm/m（四分位间距：121至422 mm/m）。无患者发生管道血栓形成。在一期诺伍德手术后的第一个月，大多数股静脉管道功能良好，尽管大多数在3个月时功能不全。7例患者需要对管道进行导管介入治疗。随访时大多数患者的右心室功能得以保留。
在诺伍德手术中使用股静脉同种异体移植物作为右心室至肺动脉管道是安全的，且与肺动脉良好发育及心室功能保留相关。在过渡期可能需要对管道进行球囊扩张。
