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重症法乐氏四联症(TOF)根治手术的关键是流出道的疏通、重建。目前,右室流出道(RVOT)重建多采用自体心包片跨肺动脉瓣环补片扩大右室流出道,因为肺动脉瓣环剪开及加宽后破坏了肺动脉瓣关闭的严密性,造成其关闭不全,致肺动脉瓣返流,加重了右室负荷,所以术后易发生心功能不全,难管理,病死率高。我们选择2000年1月至2003年6月收治的20例成人重症TOF患者应用活性同种带瓣主动脉片重建右室流出道,并与常规方法的20例进行对比研究,显示了满意效果。现报道如下。 相似文献
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目的 总结带瓣牛颈静脉补片在右室流出道重建中的临床经验和术后早期效果.方法 2006年6月至2008年12月,16例患者应用带瓣牛颈静脉补片进行右室流出道重建.与同期手术行右室流出道重建使用自体心包组术后早期进行对比.结果 全组无死亡,术后3个月超声检查右室流出道通畅,4例有轻度反流.结论 带瓣牛颈静脉作为右室流出道重建的替代材料,具有易于获取、型号齐全、早期临床效果好的特点,但中远期效果仍待随访观察. 相似文献
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人体同种主动脉瓣临床应用一附7例报告 总被引:3,自引:0,他引:3
本文报告7例液氮(-196°C)保存的人体主动脉瓣分别应用于主动脉瓣替换5例(其中1例合并瓣环扩大)、肺动脉瓣替换及法乐四联症右室流出道成形各1例.术后随访5月~6年,临床效果满意.对同种瓣的特点、同种瓣替换的手术适应证及术后遗留杂音和返流进行了讨论. 相似文献
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戊二醛处理的自体心包补片在法乐四联症矫治术中作流出道加… 总被引:1,自引:0,他引:1
我院自1983年4月至1991年4月在45例法乐四联症矫治术中,应用戊二醛处理的自体心包补片作流出道加宽缝合的方法。其中单纯行流出道加宽缝合10例,流出道并切开肺动脉瓣环加宽缝合19例,跨瓣环肺总动脉加宽缝合16例。经1-8年随访,所有病例发育正常,无后遗症。本文并对自体心包补片的制作,优点作了介绍与讨论。 相似文献
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我院自1983年4月至1991年4月在45例法乐四联症矫治术中,应用戊二醛处理的自体心包补片作流出道加宽缝合的方法。其中单纯行流出道加宽缝合10例,流出道并切开肺动脉瓣环加宽缝合19例,跨瓣环肺总动脉加宽缝合16例。经1~8年随访,所有病例发育正常,无后遗症。本文并对自体心包补片的制作,优点作了介绍与讨论。 相似文献
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同种主动脉跨环补片用于法鲁四联症根治术 总被引:1,自引:0,他引:1
本文报告6例法鲁四联症(TOF)采用同种主动脉瓣(HAV)保留二尖瓣前叶法行根治术,HAV采用液氮保存,全组均为男性,年龄2.5-8岁,均有肺动脉发育不全。跨环补片采用HAV主动脉壁加宽肺动脉,二尖瓣前叶加宽右室流出道;6例全部存活,无并发症;术后超声心动图(UCG)示右室流出道疏通满意,无肺动脉瓣返流。 相似文献
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Patrick T. Roughneen M.B.Ch.B. F.R.C.S. Serafin Y. DeLeon M.D. Sirish Parvathaneni M.D. Frank Cetta M.D. Benjamin Eidem M.D. Dolores A. Vitullo M.D. 《Echocardiography (Mount Kisco, N.Y.)》1985,2(5):370-374
Abstract Long-term pulmonary insufficiency resulting from simple transannular patching of the right ventricle outflow tract will ultimately lead to deterioration in right ventricular function. Previously, monocusps constructed from xenografts, homografts, fascia lata, and autologous pulmonary artery wall have been utilized to minimize pulmonary regurgitation and its deleterious effect on right ventricular function. However, these tend to degenerate in the long term, necessitating reoperation. To circumvent this problem we have used a monocusp constructed from 0·1−mm polytetrafluorethylene (PTFE, pericardial membrane) clinically demonstrated to be resistant to issue ingrowth and degeneration. Seven children (5 tetralogy of Fallot, 2 pulmonary stenosis) who required division of a small pulmonary an-nulus underwent monocusp construction with 0.1-mm PTFE. Three patients had previous corrective surgery. One of these patients had a bovine pericardial monocusp placed 8 years previously, which degenerated. Of the remaining two patients, one had a pulmonary valvo-tomy as a neonate, the other repair of tetralogy of Fallot with a transannular patch. At a mean (± standard deviation) follow up to 17 ± 5·8 months all patients are alive and are New York Heart Association (NYHA) Class I. Echocardiography demonstrates mild pulmonary insufficiency (PI) in 2 patients, mild to moderate PI in 4, and moderate to severe PI in 1. The presence of a pericardial membrane monocusp in the pulmonary position may, in the long term, prevent the deleterious effects of transannular patching on right ventricular dysfunction and be more resistant to degenerative changes characteristic of monocusps constructed of native pericardium or allogeneic tissue. 相似文献
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Thirty-one adult pig hearts were studied in a pulse duplicator to observe the changes induced by right ventricular outflow tract reconstruction. Six were normal hearts, 7 had a transannular outflow patch and 18 a composite monocusp patch inserted. Abnormal movements and distortion of the posterior pulmonary leaflets were observed when a patch had been inserted. The monocusp patch achieved a competent pulmonary valve although the bovine pericardial cusp had slower movements than the normal leaflet, resulting in a mild regurgitation. 相似文献
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He GW 《Heart, lung & circulation》2007,16(2):107-112
Reconstruction of the right ventricular outflow tract (RVOT) is a key procedure in repair of Tetralogy of Fallot (TOF). The procedure creates pulmonary insufficiency (PI) that may compromise the right ventricular (RV) function, particularly during late follow-up. A simple way to reduce PI is to create a monocusp patch from xenografts, homografts, fascia lata, and autologous pulmonary artery or pericardium. Each of those has limitations. The autologous pericardial valve sewn on another pericardial patch is one of the earliest monocusp patches used clinically but loses anti-PI effect soon after the operation presumably due to degeneration or absorption of the monocusp. I have therefore designed and used a new technique (folded monocusp patch) to create a monocusp for TOF repair in children and adults. The technique has been used in nine patients of the 18 TOF patients who needed transannular patch-repair in total 74 TOF repairs. The monocusp patch-repaired patients had minimal or mild PI and good RV function beyond 8-12 months. The long-term results await follow-up and further study in multi-institutions. 相似文献
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D Regensburger H H Sievers P E Lange P H Heintzen A Bernhard 《The Thoracic and cardiovascular surgeon》1981,29(6):345-347
In order to reduce postoperative pulmonary insufficiency (PI) a transannular monocusp patch was implanted in 14 patients with severe tetralogy of Fallot and hypoplastic pulmonary valve ring (group A). The results of left and right heart catheterization, obtained within one year of the correction, were compared to those of 9 patients, who received a simple transannular pericardial patch (group B). The mean maximal systolic pressure ratio between the right and left ventricle (A = 0.43 +/- 0.03; B = 0.49 +/- 0.04), the mean maximal systolic pressure gradient between the right ventricle and the pulmonary artery (A = 10.38 +/- 0.52 mmHg; B = 12.2 +/- 2.5 mmHg), and the degree of PI (A = 24.7 +/- 3.4%; B = 22.0 +/- 3.0% of total stroke volume) were not significantly different (p greater than 0.05) for the 2 groups. Although optimally implanted, the available monocusp patches cannot prevent or reduce postoperative pulmonary insufficiency in patients with severe tetralogy of Fallot. This experience suggests the need for a simple transannular pericardial patch if the pulmonary valve ring requires enlargement. 相似文献
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Croti UA Braile DM de Godoy MF Ramirez V Beani L Moscadini AC 《Arquivos brasileiros de cardiologia》2007,88(5):e118-e120
A six-year-old child was suffering from pulmonary atresia with ventricular septal defect after a total correction at 1 year of age using a bovine pericardial monocusp valve in the reconstruction of the right ventricle outflow tract. The infant evolved with significant pulmonary valve regurgitation (PVR) and right ventricle dysfunction. On reoperation, a cryopreserved pulmonary homograft (CPH) was implanted with annuloplasty utilizing a Delrin ring with the aim of avoiding geometric distortion of the vessel. After two years, an echocardiogram proved a similar state to the immediate postoperative period with slight pulmonary valve regurgitation and normal right ventricular function suggesting that this maneuver may be used as coadjuvant treatment to optimize the result of CPH implantation. 相似文献
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Lukács L L Záborszky B B Sárközy K K Arvay A 《Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital》1984,11(3):234-237
From November 1980 to May 1982, 19 patients underwent surgery in this institution for right ventricular outflow tract obstruction. Surgery was performed by placing a bovine pericardial monocusp patch across the pulmonary annulus. There was one hospital death (5.3%), and one late death. The follow-up ranged from 24 to 42 months (mean 32.5 +/- 5.3 months; total, 552 patient months). The condition of the remaining 17 patients is good. Repeat cardiac catheterization was performed in 11 patients and revealed that the right ventricular/pulmonary artery systolic gradient was reduced to 13.7 +/- 9.7 mm Hg postoperatively. Angiography showed a freely mobile, thin valve cusp. No calcification, aneurysmal dilatation, or shrinkage of the monocusp patch was observed. Our experience suggests that right ventricular outflow tract reconstruction with bovine pericardial monocusp patches can be safely performed with good hemodynamic results. 相似文献
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A Choussat X Roques M Jimenez F Sorain C Oca E Baudet 《Archives des maladies du coeur et des vaisseaux》1990,83(5):647-651
Naito suggested criteria for the optimal reconstruction of the right ventricular outflow tract in total correction of tetralogy of Fallot based on the minimum acceptable diameter of the pulmonary artery. The value of these criteria was assessed in 78 operated patients by haemodynamic measurements at surgery and 6 months after operation. Using these criteria, a ratio of right ventricular/left ventricular systolic pressure less than 0.60 was obtained with the creation of pulmonary regurgitation which was usually moderate. Long-term assessment of these results is required. 相似文献
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The efficacy of a pericardial patch in the right ventricular outflow tract (RVOT) with a monocusp valve mechanism was investigated experimentally. Hemodynamic performance of the right ventricle and angiographic competence of the valve were compared in animals after patching of the RVOT and removal of the pulmonary valve (group I), patching of the RVOT, removal of the pulmonary valve and implantation of a monocusp valve (group II), patching of the RVOT, partial removal of the pulmonary valve and implantation of a monocusp valve (group III) and a control group (IV). Postoperative effective right ventricular cardiac index, stroke volume and stroke work improved significantly from group I to III, but did not reach the control values of group IV. Angiographically the monocusp valve allowed some early diastolic regurgitation due to late closure (group II) if it was not supported by remnants of the animal's own pulmonary valve (group III). 相似文献