Slavik Z, Keeton B R, Salmon A P, Sutherland G R, Fong L V, Monro J L
Wessex Cardiac and Thoracic Centre, Southampton General Hospital, U.K.
Pediatr Cardiol. 1994 May-Jun;15(3):112-5. doi: 10.1007/BF00796321.
Between July 1974 and October 1988 19 consecutive infants (mean age 2.7 months, range 5 days to 11.7 months) underwent surgical correction for persistent truncus arteriosus by one surgeon (J.L.M.). Continuity between the right ventricle and pulmonary arteries was achieved with an antibiotic-sterilized aortic homograft (diameter 13-18 mm) together with patch closure of the ventricular septal defect. There were 3 early postoperative deaths (16%): 1 patient had severe aortic regurgitation, the other 2 had preoperative cardiac arrests. Of the latter, 1 had suffered severe cerebral damage, and the other developed recurrent pulmonary hypertensive crises and low cardiac output. The 16 survivors have been followed for 3.1-17.3 years (mean 7.8 years). Four patients required subsequent replacement of the homograft for stenosis, aortic valve replacement for regurgitation, or both (3.0, 4.0, 8.5, and 12.0 years postoperatively). Of the 16 survivors, 15 are in NYHA class I. Of the 13 patients who have not had aortic valve surgery, 9 have no evidence of stenosis or regurgitation. In the 14 children with the original homograft the median of the residual peak gradient across the right ventricular outflow tract is 15 mmHg (range 10-40 mmHg), and no patient has severe homograft regurgitation at follow-up. Repair of persistent truncus arteriosus has been achieved with low early mortality and no late mortality, which reflects excellent long-term function of the homograft. Furthermore, if truncal valve function is good at presentation, patients are unlikely to require aortic valve surgery.
1974年7月至1988年10月期间，同一位外科医生（J.L.M.）为19例连续的婴儿（平均年龄2.7个月，范围5天至11.7个月）实施了永存动脉干的外科矫治术。采用抗生素消毒的主动脉同种异体移植物（直径13 - 18 mm）实现右心室与肺动脉之间的连续性，并同时用补片闭合室间隔缺损。术后早期死亡3例（16%）：1例患者有严重主动脉瓣反流，另外2例术前发生心脏骤停。后者中，1例发生严重脑损伤，另1例出现反复的肺动脉高压危象和低心输出量。16例幸存者随访了3.1 - 17.3年（平均7.8年）。4例患者随后因狭窄需要更换同种异体移植物、因反流需要行主动脉瓣置换术或两者皆需（术后3.0、4.0、8.5和12.0年）。16例幸存者中，15例心功能为纽约心脏协会（NYHA）I级。在未接受主动脉瓣手术的13例患者中，9例无狭窄或反流证据。在14例使用原同种异体移植物的儿童中，右心室流出道残余峰值压差的中位数为15 mmHg（范围10 - 40 mmHg），随访时无患者有严重的同种异体移植物反流。永存动脉干的修复取得了较低的早期死亡率且无晚期死亡，这反映了同种异体移植物出色的长期功能。此外，如果动脉干瓣膜功能在初次就诊时良好，患者不太可能需要行主动脉瓣手术。
