法洛四联症矫治术后远期肺动脉瓣关闭不全的治疗进展

随着外科、麻醉、灌注及围术期处理技术的不断发展,法洛四联症(TOF)行常规矫治手术的手术死亡率低于2%～3%,而远期预后越来越受到关注,其中远期肺动脉瓣反流是困扰心脏外科医师和影响患者预后的重要因素;由此带来的右心室扩张、右心室功能不全、致死性心律失常等直接影响患者的生存质量和术后远期生存率。目前,对肺动脉瓣反流的治疗方法包括肺动脉瓣置换术(PVR)、介入治疗、镶嵌治疗等,PVR是治疗肺动脉瓣反流的主要方法,该方法能明显改善患者的心功能和临床症状,延长患者的生存时间;介入治疗因不需要行再次开胸手术,减少了手术创伤和手术风险,而且能改善右心室压力、肺动脉瓣反流程度,使许多患者受益。我们对TOF矫治术后远期肺动脉瓣反流的病理生理改变、PVR的手术指征、肺动脉瓣反流临床治疗进展和早期防治进行综述。

Treatment Progress of Chronic Postoperative Pulmonary Regurgitation after Surgical Repair of Tetralogy of Fallot

With the evolvement of surgical,anesthetic,perfusion,and perioperative management techniques,the mortality of routine corrective operation of tetralogy of Fallot(TOF) has been less than 2%-3%,while more and more attention has been paid to patient long-term prognosis.Chronic postoperative pulmonary regurgitation(PR) is one of the important prognostic factors which are puzzling cardiac surgeons.Subsequent right ventricle dilation,right ventricular dysfunction and fatal arrhythmias as chronic PR complications have important impact on the postoperative quality of life and long-term survival.Current treatment choice for PR includes pulmonary valve replacement(PVR),intervention,and hybrid procedures.PVR is the main surgical method for chronic PR which can significantly improve patient cardiac function and clinical symptoms,and prolong long-term survival.Intervention does not require thoracotomy once again,and can thus reduce surgical trauma and risks.Intervention is also helpful to improve right ventricular pressure conditions and PR degree.This article focuses on the pathophysiological changes of chronic PR after surgical repair of TOF,surgical indications for PVR,clinical treatment progress and early prevention of PR.