He G W, Kuo C C, Mee R B
J Thorac Cardiovasc Surg. 1986 Jul;92(1):128-37.
Twenty-five dogs were divided into three experimental groups. In each animal of Group I (10 dogs), one pulmonary valve leaflet was resected and a monocusp-bearing bovine pericardial patch was sewn into the right ventricular outflow tract. The monocusp was retracted to the patch with plicating sutures, and when the sutures were removed the monocusp became functional. In each animal of Group II (10 dogs), an incision was made in the right ventricular outflow tract along the anterior pulmonary valvular commissure and a bovine pericardial patch of adjustable width (one half, one, or one and one half times the diameter of the pulmonary valve ring) was sewn into the incision. Group III (five dogs) was the control group. During each situation of altered pulmonary valve function, in each experimental animal, the pulmonary blood flow and intracardiac pressures were measured. Pulmonary regurgitation was expressed regurgitant fraction (retrograde flow divided by net forward flow). We reached the following conclusions: In all situations where pulmonary incompetence was created, the regurgitant fraction was related directly to the width of the patch and was usually not more than half of the net forward flow when the width of the patch was less than one and a half times the pulmonary valve ring diameter. Regurgitant fraction was about half of net forward flow when one leaflet had been excised. The index of pulmonary artery diastolic pressure minus right ventricular end-diastolic pressure was sensitive and bore an inverse relationship to the degree of pulmonary regurgitation. An accurately placed monocusp-bearing patch restored pulmonary valve competence after excision of a cusp. In treating patients, we are encouraged to preserve as much pulmonary valve function as possible.
25只狗被分为三个实验组。在第一组（10只狗）的每只动物中，切除一个肺动脉瓣叶，并将带有单瓣的牛心包补片缝合到右心室流出道。用折叠缝线将单瓣拉向补片，当缝线拆除时，单瓣开始发挥功能。在第二组（10只狗）的每只动物中，沿肺动脉瓣前联合在右心室流出道做一个切口，并将宽度可调节（为肺动脉瓣环直径的二分之一、一倍或一倍半）的牛心包补片缝合到切口中。第三组（5只狗）为对照组。在肺动脉瓣功能改变的每种情况下，对每只实验动物测量肺血流量和心内压力。肺反流用反流分数表示（反流流量除以净向前流量）。我们得出以下结论：在所有造成肺功能不全的情况下，反流分数与补片的宽度直接相关，当补片宽度小于肺动脉瓣环直径的一倍半时，反流分数通常不超过净向前流量的一半。当切除一个瓣叶时，反流分数约为净向前流量的一半。肺动脉舒张压减去右心室舒张末期压力的指数很敏感，且与肺反流程度呈负相关。准确放置的带有单瓣的补片在切除一个瓣尖后可恢复肺动脉瓣功能。在治疗患者时，我们受到鼓励，要尽可能多地保留肺动脉瓣功能。
