Dharmapuram Anil, Ramadoss Nagarajan, Verma Sudeep, Gouthami Vejendla, Rao Ivatury
1 Paediatric Cardiac Sciences, KIMS Hospitals, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India.
World J Pediatr Congenit Heart Surg. 2017 Mar;8(2):174-181. doi: 10.1177/2150135116682450.
During repair of tetralogy of Fallot (TOF), when a transannular patch is needed in case of a small annulus and dysplastic pulmonary valve, we chose to reconstruct the right ventricular outflow tract by augmenting the divided anterior leaflet with an extracellular matrix (ECM) patch to produce a competent valve. In this study, we present our preliminary experience and early outcomes.
From March 2013 to December 2015, of the 206 patients who underwent primary repair of TOF, 52 required a transannular incision. The median age was 18 months and the median weight was 8.2 kg. The native hinge mechanism of the valve was preserved by dividing only the anterior leaflet at the time of the transannular incision and augmenting it with an ECM patch that was sutured to the endocardium and to the divided leaflet.
Two patients died due to reasons not related to the use of the patch. Intraoperative evaluation showed a competent pulmonary valve without significant outflow gradient. During early follow-up (median 20 months), all patients were doing well without any decongestive therapy. Valve regurgitation was assessed as severe in 2, moderate in 26, and mild in 22 patients. In the majority of patients, the valve appeared thin and pliable in spite of mild to moderate regurgitation.
Early experience with the use of ECM in repair of TOF shows satisfactory outcomes. It does not show obvious growth of the material. Long-term follow-up will be required in order to assess whether the valve function is durable without acquisition of significant regurgitation.
在法洛四联症（TOF）修复术中，当瓣环较小且肺动脉瓣发育不良需要跨环补片时，我们选择用细胞外基质（ECM）补片扩大分裂的前叶来重建右心室流出道，以形成一个功能良好的瓣膜。在本研究中，我们展示了我们的初步经验和早期结果。
2013年3月至2015年12月，在206例行TOF初次修复术的患者中，52例需要跨环切口。中位年龄为18个月，中位体重为8.2千克。在跨环切口时仅分裂前叶并用ECM补片扩大，该补片缝合至心内膜和分裂的瓣叶，从而保留瓣膜的天然铰链机制。
2例患者因与补片使用无关的原因死亡。术中评估显示肺动脉瓣功能良好，无明显流出道梯度。在早期随访（中位时间20个月）期间，所有患者情况良好，无需任何减轻充血治疗。评估瓣膜反流程度为重度的有2例，中度的有26例，轻度的有22例。在大多数患者中，尽管有轻度至中度反流，但瓣膜看起来薄且柔韧。
早期使用ECM修复TOF的经验显示出令人满意的结果。未显示材料有明显生长。需要进行长期随访以评估瓣膜功能是否持久且无明显反流。
