Bigras J L, Boutin C, McCrindle B W, Rebeyka I M
Hospital for Sick Children, University of Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 1996 Jul;112(1):33-7. doi: 10.1016/s0022-5223(96)70175-7.
In the surgical repair of tetralogy of Fallot, monocuspid valves are sometimes inserted within a transannular patch to prevent pulmonary insufficiency. To determine whether this monocuspid valve prevents short-term postoperative pulmonary insufficiency and improves clinical outcome, we reviewed clinical data and preoperative and postoperative echocardiographic variables from 61 patients who underwent one of three different procedures for repair of tetralogy of Fallot between August 1992 and March 1994. We compared features from 24 patients who had undergone transannular patch repair with a monocuspid valve (patch-valve) with those from 17 patients who had undergone patch repair without a monocuspid valve (patch) and 20 patients who had undergone repair without a transannular patch (no patch). We used the ratio of pulmonary valve insufficiency jet width to pulmonary artery diameter, as measured by color-flow Doppler flowmetry, as an index of severity of pulmonary insufficiency. Moderate to severe pulmonary insufficiency was arbitrarily defined as a ratio of at least 0.50. We found no significant differences in ratios among the patch-valve group (0.73 +/- 0.25, mean +/- standard deviation), the patch group (0.79 +/- 0.20), and the no patch group (0.59 +/- 0.23). The percentages of patients with moderate to severe pulmonary insufficiency did not differ among the three groups (patch-valve 80%, patch 90%, no patch 64%). Clinical data (including mortality, number of reoperations, intensive care unit and hospital lengths of stay, and postoperative hemodynamics) were similar in the three groups. We conclude that insertion of a monocuspid valve in repair of tetralogy of Fallot does not prevent short-term postoperative pulmonary insufficiency and does not improve immediate postoperative outcome for these patients.
在法洛四联症的外科修复中，有时会在跨环补片内植入单叶瓣膜以预防肺动脉瓣关闭不全。为了确定这种单叶瓣膜能否预防术后短期肺动脉瓣关闭不全并改善临床结局，我们回顾了1992年8月至1994年3月间接受三种不同法洛四联症修复手术之一的61例患者的临床资料以及术前和术后的超声心动图变量。我们将24例行跨环补片加单叶瓣膜修复术（补片-瓣膜组）患者的特征与17例行无单叶瓣膜的补片修复术（补片组）患者以及20例行无跨环补片修复术（无补片组）患者的特征进行了比较。我们采用彩色多普勒血流仪测量的肺动脉瓣反流束宽度与肺动脉直径之比作为肺动脉瓣关闭不全严重程度的指标。中度至重度肺动脉瓣关闭不全被随意定义为该比值至少为0.50。我们发现补片-瓣膜组（0.73±0.25，均值±标准差）、补片组（0.79±0.20）和无补片组（0.59±0.23）之间的比值无显著差异。三组中中度至重度肺动脉瓣关闭不全患者的百分比也无差异（补片-瓣膜组80%，补片组90%，无补片组64%）。三组的临床资料（包括死亡率、再次手术次数、重症监护病房和住院时间以及术后血流动力学）相似。我们得出结论，在法洛四联症修复术中植入单叶瓣膜并不能预防术后短期肺动脉瓣关闭不全，也不能改善这些患者的术后近期结局。
