Uchida T, Orita H, Fukasawa M, Hirooka S, Uchino H, Washio M
Second Department of Surgery, Yamagata University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Jun;43(6):922-7.
Peripheral pulmonary artery stenosis following the occlusion of ductus arteriosus is not rare in patients with pulmonary atresia. It is also seen after the creation of Blalock-Taussig shunt for various types of cyanotic congenital heart disease. Although pericardial patch enlargement for the pulmonary artery stenosis has been done at corrective surgery, the results were unsatisfactory because of restenosis. So, we proposed and performed a new method of pulmonary artery plasty using large rectangular heterogeneous pericardium, by which pulmonary artery could be widely enlarged from the pulmonary trunk to periphery of the stenosis. A 3-year-old female (case 1) was diagnosed with pulmonary atresia, ventricular septal defect, patent ductus arteriosus and coronary anomaly associated with left pulmonary artery stenosis. She previously received left Blalock-Taussig shunt. Another patient was a 4-year-old male (case 2) diagnosed with double-outlet right ventricle, pulmonary stenosis and patent ductus arteriosus. He also received right Blalock-Taussig shunt and had left pulmonary artery stenosis. Both patients received Rastelli operation with pulmonary artery plasty simultaneously. Rastelli operation was performed using composite graft consisted of valved heterogeneous pericardial roll and knitted Dacron graft. Post operative courses were uneventful and they were doing well one year after operation. We consider that the pulmonary artery plasty with rectangular heterogeneous pericardial patch is an effective surgical procedure to avoid restenosis compared with conventional pericardial patch enlargement or balloon pulmonary artery plasty.
动脉导管未闭封堵术后外周肺动脉狭窄在肺动脉闭锁患者中并不少见。在为各种类型的青紫型先天性心脏病施行布莱洛克 - 陶西格分流术后也可见到。尽管在矫正手术中已采用心包补片扩大肺动脉，但由于再狭窄，效果并不理想。因此，我们提出并实施了一种使用大型矩形异种心包进行肺动脉成形术的新方法，通过该方法可将肺动脉从肺动脉主干到狭窄外周广泛扩大。一名3岁女性（病例1）被诊断为肺动脉闭锁、室间隔缺损、动脉导管未闭及与左肺动脉狭窄相关的冠状动脉异常。她之前接受过左布莱洛克 - 陶西格分流术。另一名患者是一名4岁男性（病例2），被诊断为右心室双出口、肺动脉狭窄和动脉导管未闭。他也接受过右布莱洛克 - 陶西格分流术且存在左肺动脉狭窄。两名患者均同时接受了带肺动脉成形术的罗斯蒂利手术。罗斯蒂利手术使用由带瓣异种心包卷和针织涤纶移植物组成的复合移植物进行。术后病程平稳，术后一年情况良好。我们认为，与传统的心包补片扩大术或球囊肺动脉成形术相比，采用矩形异种心包补片的肺动脉成形术是一种避免再狭窄的有效手术方法。
