聚四氟乙烯人工单叶肺动脉瓣在右心室流出道重建中的应用

目的 评价在右心室流出道重建手术中应用聚四氟乙烯（PTFE）制备单叶肺动脉瓣对防治术后早期肺动脉瓣反流的作用.方法 自2011年10月至2013年10月,随机选择21例具备手术适应证的患者,先用经修剪的PTFE片缝制人工单叶肺动脉瓣,再用经处理的自体心包片行右心室及主肺动脉补片扩大.体外循环转流50～150（83.4±24.1）min,主动脉阻断30～101（58.8±19.1）min.结果 本组21例中死亡1例,病死率4.76％,余20例术后恢复良好.全组病例机械辅助呼吸4～130 h,排除死亡的病例,平均（8.2±3.4）h;ICU滞留时间1～5（1.6±1.0）d;术后住院时间5～14（6.9±2.5）d.出院前及术后3个月行超声心动图检查,除第1例患儿存在中度肺动脉反流外,其余患儿均无反流或仅表现为痕迹量反流;全部患儿均无肺动脉或右心室流出道梗阻.结论 在行跨肺动脉瓣右心室流出道补片扩大术中应用PTFE人工单叶肺动脉瓣,可以有效地改善右心室功能,而体外循环时间、主动脉阻断时间及治疗费用并没有因此而明显增加.

PTFE monocusp valve for RVOT reconstruction

Objective To assess the short term effects of PTFE monocusp pulmonary valve in the rebuilding of RVOT.Methods Between October 2011 and October 2013,21 cases were selected randomly to adapt PTFE monocusp valve for RVOT reconstruction.The mean age at operation was （3.8±2.6）years （range 1-12 years）.The mean weight at operation was （12.9±6.2）kg （range 5.5-34.0 kg）.Of all this group patients,12 cases were tetralogy of fallot,3 cases were pulmonary stenosis combined with atrial septal defect,3 cases were pulmonary stenosis,and 3 cases were double outlet of right ventricle combined with pulmonary stenosis.On the basis of routine repairing processes,we put a PTFE patch onto the RVOT incision before roofing the RVOT opening with a paricardial patch.Results 1 case died from left heart failure 130 hours after operation,other 20 cases discharged without complications.The mean ventilation assist time was （8.2±3.4）hours,ranging from 4 to 20 hours excluding the dead case,who was assisted for 130 hours.The mean length of ICU stay were （1.6±l.0）days,ranging from 1 to 5 days.The mean length of hospital stay after operations were （6.9±2.5）days,ranging from 5 to 14 days.Echocardiography evaluations before discharge and 3 months after operation show except 1 case with moderate pulmonary regurgitation,others have no or tiny pulmonary regurgitation.No residual RVOT stenosis exists.Conclusion The use of PTFE monocusp valve can prevent short-term and significantly reduce mid-term pulmonary valve insufficiency.It is inexpensive and easy to operate.