Parikh Khushboo N, Shah Nishant C, Clark Joseph B, Myers John L
Department of Pediatrics, Penn State Children's Hospital, Hershey, PA, USA.
Department of Surgery, Penn State Children's Hospital, Hershey, PA, USA.
Interact Cardiovasc Thorac Surg. 2017 Dec 1;25(6):985-986. doi: 10.1093/icvts/ivx215.
Chronic pulmonary insufficiency following transannular patch repair of tetralogy of Fallot may mandate restoration of a competent pulmonary valve. Pulmonary valve leaflets that are preserved at initial surgery may grow and develop normal morphology and subsequent valve repair may be possible. We reviewed our experience with native pulmonary valve restitution following transannular patch repair (2001-15). The cohort included 9 patients with a median age of 18.7 (range 10.6-31.3) years. Operative technique involved reapproximation of the anterior commissure of the pulmonary valve. Median length of stay was 3 days, and there were no deaths. At median follow-up of 2.0 (0.4-13.5) years, pulmonary insufficiency was graded as ≤mild (n = 4), mild-moderate or moderate (n = 4) and moderate-severe (n = 1); pulmonary stenosis was ≤mild (n = 8) and moderate (n = 1), with median peak gradient of 21 (16-64) mmHg. No patient required reintervention. At reoperation to treat pulmonary insufficiency in repaired TOF, if residual leaflets are found with favourable anatomy, restitution of the native valve should be considered. This valve-preserving technique avoids the certain failure of a bioprosthesis and is associated with favourable early outcomes. The viability of this option may influence surgeons to leave the pulmonary leaflets in situ at the time of initial repair.
法洛四联症经环瓣补片修复术后的慢性肺功能不全可能需要恢复有效的肺动脉瓣功能。初次手术时保留的肺动脉瓣叶可能会生长并发育出正常形态，随后有可能进行瓣膜修复。我们回顾了我们在经环瓣补片修复术后（2001 - 2015年）进行自体肺动脉瓣复位的经验。该队列包括9例患者，中位年龄为18.7岁（范围10.6 - 31.3岁）。手术技术包括重新对合肺动脉瓣的前联合。中位住院时间为3天，无死亡病例。在中位随访2.0年（0.4 - 13.5年）时，肺功能不全分级为≤轻度（n = 4）、轻度 - 中度或中度（n = 4）以及中度 - 重度（n = 1）；肺动脉狭窄≤轻度（n = 8）和中度（n = 1），中位峰值压差为21（16 - 64）mmHg。无患者需要再次干预。在再次手术治疗修复后的法洛四联症的肺功能不全时，如果发现残留瓣叶具有良好的解剖结构，应考虑自体瓣膜复位。这种保留瓣膜的技术避免了生物假体的必然失败，并与良好的早期结果相关。这种选择的可行性可能会影响外科医生在初次修复时将肺动脉瓣叶留在原位。
