Shimizu H, Fukuda T, Suzuki T, Oda Y
Department of Cardiovascular Surgery, Tokyo Metropolitan Kiyose Children's Hospital, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Jul;41(7):1199-203.
Twenty-four patients who underwent radical correction for two-chambered right ventricle from 1973 to 1990 were classified into 3 groups according to the method used for releasing the stenosis in the right ventricle; Group A (n = 7): resection of thickened fibrous tissue; Group B (n = 13): resection of the fibrous tissue and abnormal muscular bundles; and Group C (n = 4): resection of the fibrous tissue and abnormal muscular bundles with patch-enlargement of the right ventricular outflow tract. Postoperative cardiac catheterization was performed in the 22 patients. The pressure gradient between the right ventricle and pulmonary artery (RV-PA) at rest was 10 mmHg or less in 5 out of 7 cases in Group A, 7 out of 11 cases in Group B and all 4 cases in Group C. Isoproterenol stress test was performed in patients in whom the RV-PA pressure gradient at rest was low; the right ventricular inflow pressure increased above 50 mmHg in 3 out of 3 cases in Group A and 3 out of 4 in Group B, although it remained below 30 mmHg in 4 out of 4 cases in Group C. In conclusion, patch enlargement of the right ventricular outflow tract is the method of choice for releasing stenosis in the two-chambered right ventricle.
1973年至1990年间接受双腔右心室根治性矫正术的24例患者,根据右心室狭窄解除方法分为3组;A组(n = 7):切除增厚的纤维组织;B组(n = 13):切除纤维组织和异常肌束;C组(n = 4):切除纤维组织和异常肌束并用心包片扩大右心室流出道。22例患者术后进行了心导管检查。A组7例中有5例、B组11例中有7例、C组4例全部患者静息时右心室与肺动脉(RV-PA)之间的压力阶差为10 mmHg或更低。对静息时RV-PA压力阶差较低的患者进行了异丙肾上腺素负荷试验;A组3例中有3例、B组4例中有3例右心室流入压升至50 mmHg以上,而C组4例中有4例仍低于30 mmHg。总之,用心包片扩大右心室流出道是解除双腔右心室狭窄的首选方法。