Jin Yong-Qiang, Wu Qing-Yu, Zhang Xiao-Ya, Fan Li-Xin, Zhang En-Rui, Xue Hui, Zhang Ming-Kui
Heart Center, The First Hospital of Tsinghua University, Beijing, China.
School of Clinical Medicine, Tsinghua University, Beijing, China.
Front Cardiovasc Med. 2024 Dec 18;11:1510143. doi: 10.3389/fcvm.2024.1510143. eCollection 2024.
Surgical treatment of functional single ventricle combined with atrioventricular valve regurgitation remains a clinical challenge. The outcomes of atrioventricular valve repair in patients with single ventricle are limited.
A retrospective study was conducted of all 28 patients with functional single ventricle treated with single-ventricle palliation who underwent atrioventricular valve operation at the First Hospital of Tsinghua University between April 2007 and October 2022.
In our cohort, the female/male ratio was 7:21, with an average age of 8.7 ± 6.0 (0.75-26) years. Half of patients (50%) were right-ventricle type for single-ventricle morphology. 18 patients (64.3%) were with a common atrioventricular valve. Twenty-three patients (82.1%) were combined with heterotaxy syndrome. Pre-operatively, twenty-four patients (85.7%) were diagnosed with severe atrioventricular valve regurgitation. AVV was repaired at the Glenn ( = 16, 57.1%), Glenn-Fontan ( = 2, 7.1%) and Fontan ( = 10, 35.7%) stage, respectively. Valve plastic techniques included valve annulus/commissure constriction ( = 24), clefts repair (9 cases), edge-to-edge suturing (13 cases) and common atrioventricular valve separation (4 cases). The early mortality was 3.6% (1/28). All survival patients were observed with improved regurgitation situations. Twenty-two patients (78.5%) were observed with no more than mild regurgitation postoperatively. The mean follow-up time was 5.4 ± 2.9 years (range, 3.08-11.83 years), with late mortality of 11.1% (3/27). All these three cases were observed with a severe regurgitation by echocardiogram in the last follow-up. Besides, reoperation rate of this cohort was 3.6% (1/28).
AVV repair could significantly improve AVV function in SV patients combined with severe AVVR, with satisfactory mid-term results. Part of the cohort showed poor prognosis due to repeated AVVR. Regular follow-up by echocardiogram is critically important for these patients.
功能性单心室合并房室瓣反流的外科治疗仍然是一项临床挑战。单心室患者房室瓣修复的效果有限。
对2007年4月至2022年10月在清华大学第一医院接受单心室姑息治疗并进行房室瓣手术的28例功能性单心室患者进行回顾性研究。
在我们的队列中，女性/男性比例为7:21，平均年龄为8.7±6.0（0.75 - 26）岁。一半的患者（50%）单心室形态为右心室型。18例患者（64.3%）有共同房室瓣。23例患者（82.1%）合并内脏异位综合征。术前，24例患者（85.7%）被诊断为严重房室瓣反流。房室瓣修复分别在格林手术阶段（=16例，57.1%）、格林 - 方坦手术阶段（=2例，7.1%）和方坦手术阶段（=10例，35.7%）进行。瓣膜整形技术包括瓣环/瓣叶交界缩窄（=24例）、瓣叶裂修复（9例）、边对边缝合（13例）和共同房室瓣分离（4例）。早期死亡率为3.6%（1/28）。所有存活患者的反流情况均有改善。22例患者（78.
