Trusler G A, Yamamoto N, Williams W G, Izukawa T, Rowe R D, Mustard W T
Br Heart J. 1976 Sep;38(9):957-60. doi: 10.1136/hrt.38.9.957.
Fifty-nine children with pulmonary atresia and intact ventricular septum underwent various forms of surgical treatment at the Hospital for Sick Children, Toronto, during 1950 to mid 1975. Twenty-three patients had pulmonary valvotomy, 15 direct, 2 indirect, and 6 both direct valvotomy and infundibulectomy. All died, 19 early and 4 late. Of 13 patients who received a systemic-pulmonary artery shunt, 4 combined with surgical atrial septectomy, there are only 2 long-term survivors both of whom were children who had had a Waterston anastomosis. Recently we have been treating infants with small right ventricles with balloon atrial septostomy at cardiac catherterization followed by a Potts anastomosis and pulmonary valvotomy. If the Potts anastomosis appears satisfactory the persistent ductus arteriosus is ligated. This scheme was used in 23 infants, with 4 early deaths and 2 late deaths. Of 17 survivors, further shunts were required in 4 children. One child has had a formal repair, with insertion of valves in both tricuspid and pulmonary areas. We believe that this operative combination of Potts anastomosis and pulmonary valvotomy offers the infant with pulmonary atresia and a small right ventricle a relatively low initial mortality and the possibility of right ventricular enlargement and subsequent repair.
1950年至1975年年中，59例患有肺动脉闭锁且室间隔完整的儿童在多伦多病童医院接受了各种形式的外科治疗。23例患者接受了肺动脉瓣切开术，其中15例为直接切开，2例为间接切开，6例同时进行了直接瓣膜切开术和漏斗部切除术。所有患者均死亡，19例早期死亡，4例晚期死亡。13例接受体肺分流术的患者中，4例同时进行了外科房间隔切除术，只有2例长期存活者，他们都是接受了沃特斯顿吻合术的儿童。最近，我们在心脏导管插入术时用球囊房间隔造口术治疗右心室小的婴儿，随后进行波特斯吻合术和肺动脉瓣切开术。如果波特斯吻合术看起来令人满意，就结扎动脉导管未闭。该方案用于23例婴儿，4例早期死亡，2例晚期死亡。在17名存活者中，4名儿童需要进一步分流。1名儿童进行了正式修复，在三尖瓣和肺动脉区域均植入了瓣膜。我们认为，波特斯吻合术和肺动脉瓣切开术的这种手术组合为患有肺动脉闭锁和右心室小的婴儿提供了相对较低的初始死亡率，以及右心室扩大和随后修复的可能性。
