Couetil J P, Berrebi A, Ferdinand F D, Fornes P, Adamopoulos C, Filsoufi F, Deloche A, Carpentier A
Department of Cardiovascular Surgery and Organ Transplantation, Hôpital Broussais, University of Paris, France.
Circulation. 1998 Nov 10;98(19 Suppl):II368-71.
This study describes and evaluates the early results of a new surgical technique to reconstruct the right ventricular outflow tract and fit it with a new valve after the Ross procedure.
Between March 1996 and November 1997, 20 patients underwent a Ross operation with a new approach consisting of a direct anastomosis between the remaining pulmonary artery trunk and the infundibulum and of the creation of a monocusp tailored from the anterior pulmonary artery wall as a means of reconstructing the valve. The 20 patients (12 males and 8 females) had a mean age of 27.4 years (range, 17 to 42 years). Ten of them had predominant aortic regurgitation, 8 had aortic stenosis, and 2 had mixed disease. There were no deaths during the follow-up period of up to 20 months, no early or late repeat operations, and no specific complications secondary to the surgical technique. During the follow-up, at the aortic autograft site, 19 patients had no or trivial regurgitation, and a mild regurgitation was found in only 1 patient. Across the pulmonary monocusp, color flow Doppler demonstrated no or trivial incompetence in 10 patients, mild incompetence in 7, and moderate incompetence in 3. No significant pressure gradient was shown.
Our experience supports the use of this new surgical procedure and allows extension of the Ross operation to where there are no facilities for homografts. It may be an alternative for right ventricular outflow tract reconstruction with a homograft should the results be confirmed at long-term follow-up.
本研究描述并评估了一种新的手术技术的早期结果，该技术用于在罗斯手术（Ross procedure）后重建右心室流出道并安装新瓣膜。
1996年3月至1997年11月期间，20例患者接受了罗斯手术，采用了一种新方法，包括将剩余的肺动脉干与漏斗部直接吻合，以及从前肺动脉壁制作一个单叶瓣作为重建瓣膜的手段。这20例患者（12例男性和8例女性）的平均年龄为27.4岁（范围17至42岁）。其中10例以主动脉瓣反流为主，8例有主动脉瓣狭窄，2例有混合性病变。在长达20个月的随访期内无死亡病例，无早期或晚期再次手术，也无因手术技术导致的特定并发症。随访期间，在主动脉自体移植部位，19例患者无反流或仅有微量反流，仅1例患者发现轻度反流。通过肺动脉单叶瓣，彩色多普勒血流显像显示10例患者无反流或仅有微量反流，7例患者有轻度反流，3例患者有中度反流。未显示明显的压力阶差。
我们的经验支持使用这种新的手术方法，并使罗斯手术能够扩展到没有同种异体移植物可用的地方。如果长期随访结果得到证实，它可能是同种异体移植物用于右心室流出道重建的一种替代方法。
