Horikawa Yui, Miyahara Yoshinori, Tarui Suguru, Fujii Takanari, Tomita Hideshi, Ishino Kozo
Division of Pediatric Cardiovascular Surgery, SHOWA Medical University Hospital, Tokyo, Japan.
Division of Pediatric Cardiology, Pediatric Heart Disease and Adult Congenital Heart Disease Center, SHOWA Medical University Hospital, Tokyo, Japan.
Asian Cardiovasc Thorac Ann. 2025 Jun;33(4-5):179-187. doi: 10.1177/02184923251350362. Epub 2025 Jun 12.
BackgroundValve-sparing repair for tetralogy of Fallot is challenging in patients with hypoplastic pulmonary valves. Recently, we adopted transannular incision and delamination. This study evaluates its feasibility for right ventricular outflow relief, valve function, and growth.MethodsWe retrospectively reviewed records of patients with tetralogy of Fallot or Fallot-type double-outlet right ventricle who underwent intracardiac repair from October 2013 to December 2020.ResultsTwenty-six patients were enrolled. Two patients who underwent the Rastelli procedure were excluded, leaving 24 for evaluation. Eleven underwent valve-sparing repair, eight underwent valve-preserving repair with transannular delamination, and five underwent the transannular patch procedure. The median age and weight at surgery were 11.7 months (1.9-40.2 months) and 7.6 kg (3.7-12.7 kg). No patients died or required reintervention for pulmonary valve stenosis or regurgitation during a median follow-up of 42.5 months (4.6-72.1 months). In the delamination group, the mean preoperative pulmonary valve z-score was -2.1 ± 1.0, improving significantly to 0.2 ± 0.8. Pulmonary regurgitation was mild in six of eight patients, while two with the smallest preoperative annulus developed moderate regurgitation. Despite no significant difference in the preoperative pulmonary valve annulus between the delamination and transannular patch groups, the delamination group had significantly lower postoperative pulmonary valve regurgitation, while no significant difference in stenosis.ConclusionsValve-preserving repair using the transannular delamination technique is feasible in patients with tetralogy of Fallot, reducing pulmonary regurgitation and avoiding transannular patch use. Long-term data with more patients are required to show the utility of this approach.
背景
对于肺动脉瓣发育不全的法洛四联症患者，保留瓣膜的修复手术具有挑战性。最近，我们采用了经环切开和分层技术。本研究评估其在缓解右心室流出道梗阻、瓣膜功能及生长方面的可行性。
方法
我们回顾性分析了2013年10月至2020年12月期间接受心内修复术的法洛四联症或法洛型右心室双出口患者的病历。
结果
共纳入26例患者。2例行Rastelli手术的患者被排除，剩余24例进行评估。11例行保留瓣膜修复术，8例行经环分层保留瓣膜修复术，5例行经环补片手术。手术时的中位年龄和体重分别为11.7个月（1.9 - 40.2个月）和7.6千克（3.7 - 12.7千克）。在中位随访42.5个月（4.6 - 72.1个月）期间，无患者死亡，也无患者因肺动脉瓣狭窄或反流需要再次干预。在分层组中，术前肺动脉瓣z值平均为 -2.1±1.0，术后显著改善至0.2±0.8。8例患者中有6例肺动脉反流轻度，而术前瓣环最小的2例出现中度反流。尽管分层组和经环补片组术前肺动脉瓣环无显著差异，但分层组术后肺动脉瓣反流显著更低，而狭窄程度无显著差异。
结论
对于法洛四联症患者，采用经环分层技术保留瓣膜的修复术是可行的，可减少肺动脉反流并避免使用经环补片。需要更多患者的长期数据来证明这种方法的效用。
