Yoshii S, Suzuki S, Hosaka S, Komuro N, Kato J, Tada Y, Hashimoto R
Department of Surgery, Yamanashi Medical University, Japan.
Kyobu Geka. 1996 Nov;49(12):1022-5.
The surgical treatment for truncal valve regurgitation is still controversial in patients with truncus arteriosus. A two-year-old girl with complaints of low weight gain and tachypnea was referred for treatment of truncal valve regurgitation. She had undergone an emergency pulmonary artery banding for severe congestive heart failure due to truncus arteriosus-type I at six months of age. This anomaly had been corrected by Barbero-Marcial method at seven months of age. But the truncal valve regurgitation started appearing at sixteen months of age with the progression of the stenosis of the pulmonary artery orifice and the right ventricular outflow tract regurgitation. Echo cardiography and cineangiography revealed the truncal valve to be bicuspid, and the regurgitation severe, especially through the prolapsed left sided cusp. The truncal valve was repaired by commissural suspension method, and the right ventricular outflow tract reconstructed with patch angioplasty of the pulmonary artery orifice and Carpentier-Edwards pericardial Bioprosthesis (19 mm). The post-operative course was uneventful. One year after, truncal valve regurgitation is small by color Doppler study. We conclude that valvoplasty is to be considered as the first choice of treatment for truncal valve regurgitation.
对于共同动脉干患者，其动脉干瓣膜反流的外科治疗仍存在争议。一名两岁女童因体重增加缓慢和呼吸急促前来就诊，接受动脉干瓣膜反流治疗。她在六个月大时因I型共同动脉干导致的严重充血性心力衰竭接受了紧急肺动脉环扎术。七个月大时通过巴贝罗 - 马尔西亚尔方法矫正了这一异常。但在16个月大时，随着肺动脉口狭窄和右心室流出道反流的进展，动脉干瓣膜反流开始出现。超声心动图和心血管造影显示动脉干瓣膜为二叶式，反流严重，尤其是通过脱垂的左侧瓣叶。采用瓣叶联合悬吊法修复动脉干瓣膜，并用肺动脉口补片血管成形术和卡彭蒂埃 - 爱德华兹心包生物瓣膜（19毫米）重建右心室流出道。术后过程顺利。一年后，彩色多普勒检查显示动脉干瓣膜反流轻微。我们得出结论，瓣膜成形术应被视为动脉干瓣膜反流治疗的首选方法。
