Kasturi Srikanth, Prabhu Sudesh
Department of Cardiothoracic Surgery Narayana Institute of Cardiac Sciences Bengaluru, India.
Multimed Man Cardiothorac Surg. 2020 May 26;2020. doi: 10.1510/mmcts.2020.023.
Right ventricle to pulmonary artery conduits such as homografts and pre-manufactured synthetic conduits are widely employed in the present era of complex congenital cardiac surgeries for disorders involving right ventricle - pulmonary artery discontinuity and major coronary artery crossing the right ventricular outflow tract. The key drawback of homograft conduits is the need for reoperation to replace them as a result of degeneration over time or in cases where a child has outgrown the conduit and cost is a major drawback to using commercially available conduits. The advantages of expanded polytetrafluoroethylene are its long-term durability in terms of conduit calcification/degeneration and valve stenosis/regurgitation and its cost-effectiveness. In this video presentation, we demonstrate the preparation and intraoperative usage of a handmade, trileaflet, valved polytetrafluoroethylene conduit in a case of double outlet right ventricle with valvular and subvalvular pulmonary stenosis and the left anterior descending artery crossing the right ventricular outflow tract. Our experience with this handmade conduit is close to 120 cases and we have seen excellent postoperative recovery and results. Our medium-term follow-up echocardiographic evidence shows conduit patency and preserved valve function.
右心室至肺动脉管道，如同同种异体移植物和预制合成管道，在当今复杂先天性心脏手术时代被广泛应用于涉及右心室 - 肺动脉连续性中断以及主要冠状动脉跨越右心室流出道的疾病。同种异体移植物管道的主要缺点是，由于随着时间推移发生退变，或者在儿童生长到管道不再适用的情况下，需要再次手术进行更换，而且使用市售管道成本是一个主要问题。膨体聚四氟乙烯的优点在于其在管道钙化/退变以及瓣膜狭窄/反流方面具有长期耐久性，并且具有成本效益。在本视频展示中，我们演示了在一例具有瓣膜和瓣膜下肺动脉狭窄且左前降支动脉跨越右心室流出道的右心室双出口病例中，手工制作的三叶瓣带瓣聚四氟乙烯管道的制备及术中使用情况。我们使用这种手工制作管道的经验接近120例，并且我们看到了出色的术后恢复情况和结果。我们的中期随访超声心动图证据显示管道通畅且瓣膜功能得以保留。
