Pacifico A D, Kirklin J W, Blackstone E H
J Thorac Cardiovasc Surg. 1977 Sep;74(3):382-95.
Fifty-five consecutive patients with the tetralogy of Fallot underwent intracardiac repair in a 12 month period. A standardized protocol for outflow tract enlargement was used. When the measured diameter of the pulmonary valve ring was at least the "minimum acceptable pulmonary valve ring diameter," primary patch-graft enlargement across the valve ring was not done (Group I, 34 patients); when it was less, primary patch-graft enlargement was done (Group II, 21 patients). The right ventricular-left ventricular systolic pressure ratio (PRV/LV) after repair without patch-graft enlargement across the ring was related to the size of the ring. Sixteen (94 percent) of 17 such patients with normal-sized or large pulmonary valve rings (according to the criteria of Rowlatt, Rimoldi, and Lev) had PRV/LV equal to or less than 0.65; four (80 percent) of five patients with smaller rings but within the 50 percent confidence limits had PRV/LV equal to or less than 0.65; five (56 percent) of nine with still smaller rings but within the 72.5 percent confidence limits had PRV/LV equal to or less than 0.65. In Group II, 15 patients had abnormally small rings, but after patch-graft enlargement the mean PRV/LV was 0.44 +/- 0.140. A surgical protocol based on these data has been developed.
在12个月期间，连续55例法洛四联症患者接受了心内修复术。采用了标准化的流出道扩大方案。当测量的肺动脉瓣环直径至少为“可接受的最小肺动脉瓣环直径”时，不进行跨瓣环的原发性补片移植扩大术（I组，34例患者）；当直径较小时，则进行原发性补片移植扩大术（II组，21例患者）。未进行跨瓣环补片移植扩大术的修复术后右心室与左心室收缩压比值（PRV/LV）与瓣环大小有关。根据Rowlatt、Rimoldi和Lev的标准，17例肺动脉瓣环大小正常或较大的此类患者中有16例（94%）的PRV/LV等于或小于0.65；5例瓣环较小但在50%置信区间内的患者中有4例（80%）的PRV/LV等于或小于0.65；9例瓣环更小但在72.5%置信区间内的患者中有5例（56%）的PRV/LV等于或小于0.65。在II组中，15例患者的瓣环异常小，但补片移植扩大术后PRV/LV的平均值为0.44±0.140。已根据这些数据制定了一项手术方案。
