Black M D, Adatia I, Freedom R M
Division of Cardiovascular Surgery, The Hospital for Sick Children and the University of Toronto, Ontario, Canada.
Ann Thorac Surg. 1998 Jun;65(6):1737-40. doi: 10.1016/s0003-4975(98)00136-2.
The identification of moderate to severe preoperative truncal valve regurgitation has been synonymous with significant postoperative mortality after neonatal repair of truncus arteriosus. Spurned by the deficiencies of current truncal valve substitutes surgeons are once again reexamining the option of truncal valve reparative techniques.
From May 1996 until June 1997, 8 children underwent correction of truncus arteriosus. A retrospective analysis was conducted.
There was one in-hospital death secondary to a postoperative massive coronary air embolism. Moderate-to-severe truncal valve regurgitation was identified clinically and confirmed with cardiac ultrasound in 3 neonates with a mean age of 7 days (range, 4 to 12 days) all with quadracusp truncal valves. Successful truncal valve repair was accomplished in 2 infants, with a third neonate requiring homograft replacement with coronary reimplantation for failure in achieving valvular competence after attempted valvuloplasty. Postoperative echocardiograms in those neonates who underwent truncal valve repair confirmed a functional "tricuspid" valve with only mild to mild-plus regurgitation.
We give further credence to the hypothesis that primary neonatal truncal valve repair is feasible and may be successful in the avoidance and delay of serial truncal valve replacements using either mechanical or allograft substitutes.
术前发现中重度动脉干瓣膜反流一直被认为与新生儿动脉干矫治术后的高死亡率密切相关。由于目前动脉干瓣膜替代品存在缺陷，外科医生再次重新审视动脉干瓣膜修复技术的选择。
1996年5月至1997年6月，8例儿童接受了动脉干矫治术。进行了回顾性分析。
1例因术后大量冠状动脉空气栓塞在院内死亡。3例平均年龄7天（范围4至12天）的新生儿临床上发现中重度动脉干瓣膜反流，并经心脏超声证实，均为四叶式动脉干瓣膜。2例婴儿成功完成动脉干瓣膜修复，第3例新生儿因瓣膜成形术未能实现瓣膜功能而需要同种异体瓣膜置换并冠状动脉再植。接受动脉干瓣膜修复的新生儿术后超声心动图证实为功能性“三尖瓣”瓣膜，仅有轻度至轻度+反流。
我们进一步相信这一假设，即原发性新生儿动脉干瓣膜修复是可行的，并且在避免和延迟使用机械或同种异体替代品进行系列动脉干瓣膜置换方面可能是成功的。
