Congenital and Structural Heart Disease Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Department of Pediatric Cardiology, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain.
Congenital and Structural Heart Disease Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Cardiovascular Surgery, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain.
Semin Thorac Cardiovasc Surg. 2019 Winter;31(4):828-834. doi: 10.1053/j.semtcvs.2019.04.007. Epub 2019 Apr 18.
Deleterious long-term effects of chronic pulmonary regurgitation after repair of tetralogy of Fallot have become evident during the last decades. Subsequently, some groups have developed strategies to spare the pulmonary valve function at the time of repair with good early results. However, mid-term outcomes are scarce in the literature and in some cases controversial. The aim of our study is to report our results mid-term with valve-sparing repair of tetralogy of Fallot. We retrospectively reviewed patients undergoing tetralogy of Fallot repair and having preservation of the pulmonary valve with intraoperative dilation at our institution. From June 2009 through June 2017, 42 patients underwent valve-sparing tetralogy of Fallot repair. Median age and weight at surgery were 5.2 months and 7.2 kg. Median preoperative pulmonary valve diameters and Z scores by echocardiography were 6.4 mm (range 4.5-11 mm) and -2.3 (range -1.3 to -4.5). No patient died in our series. For a median follow-up of 45 months, the pulmonary valve has grown by Z score (P < 0.0001) as well as the pulmonary trunk (P= 0.00216). Significant pulmonary regurgitation has developed in 9 patients (21.4%). No patient has required reintervention/reoperation for recurrent right ventricular outflow tract obstruction. Patients with tetralogy of Fallot who had valve-sparing repair with intraoperative dilation of the pulmonary valve show good early and mid-term results with respect to right ventricular outflow tract obstruction. The pulmonary valve annulus and the pulmonary trunk grow through follow-up. Progressive development of significant pulmonary regurgitation is seen in more than 20% of patients. Long-term data with this approach and comparison with a population of patients undergoing a transannular patch repair are required to establish the real utility of this approach.
先天性心脏病室间隔完整型肺动脉闭锁矫治术后出现慢性肺动脉瓣反流的长期不良影响在过去几十年中已经显现出来。随后，一些研究小组制定了在矫治术时保留肺动脉瓣功能的策略，早期结果良好。然而，该方法的中期结果在文献中相对较少，在某些情况下存在争议。本研究旨在报告我们应用保留肺动脉瓣的矫治术治疗法洛四联症的中期结果。我们回顾性分析了在我院行保留肺动脉瓣的矫治术的患者，这些患者术中采用了肺动脉瓣扩张。2009 年 6 月至 2017 年 6 月，42 例患者接受了保留肺动脉瓣的法洛四联症矫治术。手术时的中位年龄和体重分别为 5.2 个月和 7.2kg。超声心动图测量的术前肺动脉瓣直径和 Z 评分中位数分别为 6.4mm（范围 4.5-11mm）和-2.3（范围-1.3 至-4.5）。本研究中无患者死亡。中位随访 45 个月时，肺动脉瓣 Z 评分（P<0.0001）和肺动脉干（P=0.00216）均有所增加。9 例（21.4%）患者出现中重度肺动脉瓣反流。无患者因右心室流出道梗阻而需要再次干预/手术。在接受术中肺动脉瓣扩张的保留肺动脉瓣的矫治术后，法洛四联症患者的右心室流出道梗阻有良好的早期和中期结果。随访中肺动脉瓣环和肺动脉干都在生长。超过 20%的患者出现进行性中重度肺动脉瓣反流。需要该方法的长期数据和与行跨瓣环补片修复术的患者进行比较，以确定该方法的实际应用价值。
