非常规右心室切口根治法洛四联症

目的:采用非常规右心室切口手术的方法根治法洛四联症(TOF)。方法:2005年5月至2008年2月采用经右心房/肺动脉途径外科根治TOF患者83例。年龄5个月~25岁,平均(22.33±6.41)个月;体质量6.5~51.5 kg,平均(13.18±4.48)kg。28例采用单纯右心房切口;51例右心房加肺动脉联合切口,其中42例跨肺动脉瓣环补片扩大右心室流出道(右心室切口长5~20 mm);另4例经右心房及右心室小切口进行右心室流出道疏通。室间隔缺损经右心房切口连续缝合补片修复81例,另2例经右心房/肺动脉切口2侧修复。结果:术中停止体外循环后,65例采用直接心脏表面穿刺或通过漂浮导管检测,收缩期右心室压/体循环压(RVP/SAP)比值为0.3~0.81,平均(0.41±0.15);收缩期右心流出道残存压差(GRVP-PAP)为8~55 mm Hg(1 mm Hg=0.133 kPa)。术后早期死亡1例。结论:采用右心室微创的手术方法根治法洛四联症在技术上是可行的,操作简单,早期临床效果满意,对中晚期结果可能有潜在的益处。

The experience of minimal invasive right ventricle for repair of tetralogy of Fallot

Objective:To report the preliminary experiences of transatrial-transpulmonary repair of tetralogy of Fallot.Method:83 patients with tetralogy of Fallot underwent total correction during the period from May 2005 to Feb 2008.Their ages ranged from 5 months to 25 years [mean(22.33±6.41) months];Weight ranged from 6.5-51.5 kg[mean(13.18±4.48)kg].The infundibular mobilization and resection was made through atrialtomy in 28 patients,through atrialtomy-pulmonary arteriotomy in 51 patients,and transatril-a small right ventricular incision in the other 4 cases.For 42 patients,the pulmonary incision was extended via the small pulmonary annulus for 5 to 20 mm onto the right ventricular free wall.The ventricular septal defect was closed through the right atrium in 81 patients and via right atrial-pulmonary artery in 2 patient with subpulmonary defect.Result:The ratio of systolic right ventricular pressure to systemic arterial pressure was 0.3-0.81(0.42±0.15).The residual gradient pressure from right ventricle to pulmonary artery was 8-55 mm Hg(1 mm Hg=0.133 kPa).Residual shunt was not found at ventricular septum by echocardiogram in all patients.One patient were died in the early postoperative period.Conclusion:This report indicates that successful repair of tetraloty of Fallot can be accomplished by a transatrial-transpulmonary approach with minimal invasive right ventricle,which may provide a more intact right ventricle morphologically.