Ando M, Imai Y, Hoshino S, Ishihara K
Heart Institute of Japan, Tokyo Women's Medical College
Ann Thorac Surg. 1995 Mar;59(3):621-5. doi: 10.1016/0003-4975(94)00959-7.
Between 1991 and 1993, 5 patients underwent reoperation for critical stenosis of extracardiac conduit. Indication for extracardiac conduit repair was pulmonary truncal atresia in 3 patients and coronary anomaly including single left coronary artery and left anterior descending artery from right coronary artery in 2 patients. Age at reoperation ranged from 8 to 23 years (mean, 16.2 years). Preoperative systolic pressure ratio of right to left ventricles ranged from 0.83 to 1.05 (mean, 0.93), with the pressure gradient across the conduit ranging from 52 to 100 mm Hg (mean, 74.4 mm Hg). At reoperation, stenotic conduit was completely removed and central pulmonary artery was extensively mobilized. In 4 patients who had a relatively short distance (15 to 25 mm) between the pulmonary arterial stump and the right ventriculotomy incision, the distal pulmonary arterial stump was anastomosed directly to the cranial margin of the right ventriculotomy incision to serve as a floor mode of autologous tissue. In 1 patient with a long distance (40 mm), right ventricular-pulmonary arterial continuity was restored with a tailored autologous pericardial tube. There were no early or late deaths. Postoperative catheterization study revealed a satisfactory reduction of right ventricular pressure with the systolic pressure ratio ranging from 0.42 to 0.51 (mean, 0.47) and the pressure gradient across the right ventricular outflow tract ranged within 13 mm Hg (mean, 5 mm Hg). Restoration of right ventricular-pulmonary arterial continuity was successfully achieved by introducing the concept of autologous tissue repair even at reoperation instead of the insertion of new extracardiac conduit in patients with tetralogy of Fallot after extracardiac conduit repair.
1991年至1993年间，5例患者因心外管道严重狭窄接受了再次手术。心外管道修复的指征为3例患者存在肺动脉干闭锁，2例患者存在冠状动脉异常，包括单支左冠状动脉以及右冠状动脉发出的左前降支。再次手术时的年龄为8至23岁（平均16.2岁）。术前右心室与左心室收缩压比值为0.83至1.05（平均0.93），管道两端的压力阶差为52至100 mmHg（平均74.4 mmHg）。再次手术时，将狭窄的管道完全切除，并广泛游离中央肺动脉。4例肺动脉残端与右心室切开切口之间距离相对较短（15至25 mm）的患者，将远端肺动脉残端直接吻合至右心室切开切口的头侧边缘，作为自体组织的基底模式。1例距离较长（40 mm）的患者，采用定制的自体心包管恢复右心室与肺动脉的连续性。无早期或晚期死亡病例。术后导管检查显示右心室压力明显降低，收缩压比值为0.42至0.51（平均0.47），右心室流出道的压力阶差在13 mmHg以内（平均5 mmHg）。对于法洛四联症患者在心外管道修复后再次手术时，通过引入自体组织修复的概念，成功实现了右心室与肺动脉连续性的恢复，而不是插入新的心外管道。
