Khan Yasir, Shahabuddin Syed, Amanullah Muneer
Section of Cardiothoracic, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Ann Med Surg (Lond). 2020 Sep 1;58:107-111. doi: 10.1016/j.amsu.2020.08.023. eCollection 2020 Oct.
Right ventricular outflow tract continuity abnormalities are one of the most commonly encountered entities in the field of congenital cardiac surgery. Various strategies including homograft, valve conduit, Contegra are used to restore continuity between right ventricle and pulmonary artery. In countries like Pakistan these may not be easily available and affordable. We report the experience of our short observational study of using a handmade trileaflet valve conduit to reconstruct the right ventricular outflow tract.
From September 2015 to December 2016, a total of 15 patients with different congenital heart diseases underwent open-heart surgery at our institute. Restoration of right ventricular to pulmonary artery continuity was achieved using handmade valve conduit utilizing bovine pericardium and thin sheet PTFE sheets (0.1 mm) as conduit and valve respectively.
Patients ranged from 1 to 16 years. Seven patients had previous palliation including 4 blalock taussig (BT) Shunts and 3 pulmonary artery (PA) banding. Postoperative complications were observed in 4 patient including 2 in hospital deaths and 2 required interventions. One patient developed aneurysm at RV- conduit junction requiring surgical repair and the other underwent conduit dilatation for moderate to severe stenosis (gradient 60 mmHg). No significant regurgitation was observed in this series. Overall postoperative gradients were stable with mean gradient 25.3 mmHg (8 mmhg - 60 mmHg).
The use of handmade valve conduits has acceptable morbidity and mortality. These are cost effective alternatives in this part of the world, where well-established conduits have cost implications and uncertain availability.
右心室流出道连续性异常是先天性心脏外科领域最常见的病症之一。包括同种异体移植物、瓣膜管道、康蒂格拉（Contegra）在内的各种策略被用于恢复右心室与肺动脉之间的连续性。在巴基斯坦等国家，这些可能不容易获得且价格昂贵。我们报告了使用手工制作的三叶瓣瓣膜管道重建右心室流出道的短期观察研究经验。
2015年9月至2016年12月，共有15例患有不同先天性心脏病的患者在我们研究所接受了心脏直视手术。使用手工制作的瓣膜管道实现右心室至肺动脉的连续性恢复，该管道分别利用牛心包和薄聚四氟乙烯片（0.1毫米）作为管道和瓣膜。
患者年龄从1岁到16岁不等。7例患者曾接受过姑息治疗，包括4例布劳克-陶西格（BT）分流术和3例肺动脉（PA）环扎术。4例患者出现术后并发症，包括2例住院死亡和2例需要干预的情况。1例患者在右心室-管道交界处出现动脉瘤，需要手术修复，另1例因中度至重度狭窄（压差60毫米汞柱）接受了管道扩张术。该系列中未观察到明显反流。总体术后压差稳定，平均压差为25.3毫米汞柱（8毫米汞柱 - 60毫米汞柱）。
使用手工制作的瓣膜管道具有可接受的发病率和死亡率。在世界的这一地区，这些是具有成本效益的替代方案，因为成熟的管道存在成本问题且供应不确定。
