Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital Hsin-Chu branch, Hsin-Chu, Taiwan.
Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
J Thorac Cardiovasc Surg. 2018 Mar;155(3):1186-1189. doi: 10.1016/j.jtcvs.2017.09.148. Epub 2017 Nov 16.
Quadricuspid truncal valves are susceptible to regurgitation, and tricuspid configuration is considered more durable after repairing the truncal valve. We report a new method by excising the excessive truncal cuspid to reconstruct a new competent aortic valve.
Bilateral pulmonary banding failed to stabilize a 4-month-old baby with type I truncus arteriosus and quadricuspid truncal valve with severe regurgitation, so surgery was performed. The aorta was transected, and the pulmonary arteries was separated from the aorta. There was an excessive cusp between the right coronary and left coronary cusp. A transannular incision was carried into the right ventricular outflow tract through the left border of the right coronary cusp. We performed truncal valve repair by translocating the excessive cusp, its annulus, and its wall to the right ventricular outflow tract side and reconstructing the neoaortic valve to tricuspid. Ventricular septal defect was repair through a right ventricular outflow tract approach. The floor of the right ventricular outflow tract was made from the excised cusp, including its wall and the resected posterior aortic wall. Then the anterior wall was reconstructed with bovine pericardial patch with a 19-mm porcine valve.
Postoperative echocardiography confirmed a tricuspid neo-aortic valve with trivial aortic regurgitation, no residual ventricular septal defect, and a patent right ventricular outflow tract.
We present the surgical technique to repair a quadricuspid truncal valve insufficiency by using the excessive anterior cusp and its pedicled flap for reconstruction of the pulmonary pathway and restoration of the tricuspid truncal valve.
四叶式干瓣容易出现反流，修复干瓣后三尖瓣结构被认为更耐用。我们报告了一种通过切除多余干瓣来重建新的有效主动脉瓣的新方法。
双侧肺动脉带未能稳定一名 4 个月大的Ⅰ型大动脉转位伴严重反流的四叶式干瓣患儿，因此进行了手术。横断主动脉，将肺动脉从主动脉分离。右冠状动脉瓣和左冠状动脉瓣之间有一个多余的瓣叶。通过右冠状动脉瓣的左侧在肺动脉流出道内做一个跨瓣切口。我们通过将多余的瓣叶、瓣环及其壁移至右心室流出道侧来进行干瓣修复，并将新的主动脉瓣重建为三尖瓣。通过右心室流出道途径修复室间隔缺损。右心室流出道底部由切除的瓣叶及其壁和切除的后主动脉壁制成。然后用牛心包补片重建前壁，并用 19mm 的猪瓣。
术后超声心动图证实新的三尖瓣式主动脉瓣仅有轻微的主动脉瓣反流，无残余室间隔缺损，右心室流出道通畅。
我们提出了一种通过使用多余的前瓣叶及其带蒂瓣叶来修复四叶式干瓣关闭不全的手术技术，用于重建肺动脉通道和恢复三尖瓣干瓣。
