Matthews H R, Belsey R H
Thorax. 1973 Jan;28(1):1-8. doi: 10.1136/thx.28.1.1.
It is now generally accepted that a certain proportion of children with severe tetralogy of Fallot are anatomically unsuitable for one-stage total correction of the anomaly. The choice of the best preliminary operation for these is still in some doubt, however. Following Brock's original hypothesis that relief of the outflow obstruction will encourage enlargement of the main pulmonary artery and annulus (and therefore favour subsequent successful total correction) we have preferred this procedure in all cases not suitable for immediate total correction. In a consecutive series of 36 cases the results have been found to be very acceptable and to compare favourably with those obtained with anastomotic procedures such as the Blalock or Waterston shunt. The operation has been accomplished with an 11% mortality, and in 72% of cases cyanosis has been abolished under conditions of normal exercise. Sixteen cases have subsequently come to total correction with a 25% mortality and a 75% `cure' rate. In the light of this experience we find that closed pulmonary valvotomy with or without infundibular resection has a definite and valuable place in the current treatment of Fallot's tetralogy. General and specific indications for its use are presented.
现在人们普遍认为，一定比例的重症法洛四联症患儿在解剖结构上不适合对该畸形进行一期完全矫正。然而，对于这些患儿而言，最佳初步手术方式的选择仍存在一定疑问。继布罗克最初的假说，即解除流出道梗阻将促使主肺动脉和肺动脉瓣环扩大（从而有利于随后成功进行完全矫正）之后，对于所有不适合立即进行完全矫正的病例，我们更倾向于采用这种手术方式。在连续的36例病例中，结果令人非常满意，与诸如布莱洛克或沃特斯顿分流术等吻合手术的结果相比更具优势。该手术的死亡率为11%，在72%的病例中，患儿在正常活动情况下紫绀消失。随后有16例进行了完全矫正，死亡率为25%，“治愈率”为75%。鉴于这一经验，我们发现，无论是否进行漏斗部切除术的闭式肺动脉瓣切开术在目前法洛四联症的治疗中具有明确且重要的地位。文中给出了其使用的一般和特殊指征。
