Gore-Tex在右心室流出道重建术中的应用

目的探讨0.1 mm厚聚四氟乙烯(Gore-Tex)片制作肺动脉单瓣跨环补片重建右心室流出道的近中期临床疗效。方法76例合并肺动脉狭窄或畸形的先天性心脏病患儿,其中法洛四联症(tetralogy of Fallot,TOF)合并肺动脉狭窄55例,TOF合并Ⅰ型肺动脉闭锁7例,TOF合并肺动脉瓣缺如5例,右心室双出口合并肺动脉狭窄3例,TOF行改良Blalock-Taussig分流术后6例(左侧改良Blalock-Taussig分流术5例,右侧1例),均行矫治术,术中使用Gore-Tex片制作肺动脉单瓣跨环补片重建右心室流出道。比较术前与术中停体外循环后血氧饱和度、肺动脉干直径等差异,随访观察手术效果。结果76例均顺利完成手术,体外循环时间118(109,134)min,主动脉阻断时间86(77,102)min,术后呼吸机辅助时间88(45,99)h,ICU停留时间135(114,161)h;术后因心包压塞急诊二次手术1例,发生一过性低心排血量综合征2例、心律失常2例、肺部感染1例,均经对症治疗后恢复;1例室间隔微小残余分流(流速<2.5 m/s),术后6个月自行闭合。术中停体外循环后血氧饱和度[96.00(94.00,97.00)%]较术前[84.00(78.00,89.00)%]增高,肺动脉干直径[12.00(10.12,13.00)mm]较术前[6.60(5.80,7.50)mm]增加,肺动脉瓣压差[21.00(16.00,27.00)mm Hg]、肺动脉瓣上流速[2.31(2.00,2.70)m/s]较术前[86.00(72.00,94.75)mm Hg、4.60(4.20,5.10)m/s]降低(P<0.05)。术后随访3~48个月,超声心动图示73例肺动脉瓣瓣叶活动良好,开启闭合正常;3例轻度肺动脉瓣狭窄,随访期间未见进一步加重;5例肺动脉瓣轻度关闭不全;均无肺动脉单瓣的撕裂、黏连、增厚、钙化、血栓形成及感染等。结论右心室流出道重建中术应用Gore-Tex片制作肺动脉单瓣有较好的近中期抗反流作用,可改善右心功能。

Application of Gore-Tex in right ventricular outflow tract reconstruction

Objective To investigate the short-and mid-term clinical effect of a 0.1 mm thick Gore-Tex film for single pulmonary valve reconstruction of right ventricular outflow tract.Methods In 76 children with congenital heart disease complicated with pulmonary stenosis or deformity,55 suffered from tetralogy of Fallot(TOF)and pulmonary stenosis,7 suffered from TOF and pulmonary atresia,5 suffered from TOF and pulmonary valve deficiency,3 suffered from right ventricle double outlet and pulmonary stenosis,and 6 suffered from TOF after modified Blalock-Taussig shunt(modified Blalock-Taussig shunt on the left in 5 and on the right in 1).All patients were performed corrective surgery to reconstruct right ventricular outflow tract by using a single-loop transannular patch during the operation.The surgical outcome was observed.Results All these 76 patients completed operation successfully,with the cardiopulmonary bypass time of 118(109,134)min,aortic cross clamp time of 86(77,102)min,postoperative ventilator assistance time of 88(45,99)h,and ICU stay of 135(114,161)h.After operation,emergency secondary operation due to pericardial tamponade was performed in 1 patient,transient low cardiac output syndrome occurred in 2 patients,arrhythmia in 2 and pulmonary infection in 1,and all recovered after symptomatic treatment.The interventricular septum with minimal residual shunt(flow velocity<2.5 m/s)in 1 patient was closed spontaneously 6 months after operation.Blood oxygen saturation,pulmonary artery diameter,pulmonary valve pressure difference,and pulmonary valve flow velocity were improved after cardiopulmonary bypass(96.00(94.00,97.00)%,12.00(10.12,13.00)mm,21.00(16.00,27.00)mm Hg,2.31(2.00,2.70)m/s)compared with those before operation(84.00(78.00,89.00)%,6.60(5.80,7.50)mm,86.00(72.00,94.75)mm Hg,4.60(4.20,5.10)m/s)(P<0.05).The 3-to 48-month echocardiography showed that 73 patients had good leaflet activity,normal opening and closing;3 patients had mild single valve stenosis with no aggravation during follow-up survey;5 patients had mild pulmonary valve insufficiency;no tearing,damage,shedding,calcification,thrombosis or infection of pulmonary valve occurred.ConclusionIn the reconstruction of right ventricular outflow tract,single pulmonary artery valve with Gore-Tex film has a good short-and mid-term anti-reflux effect,which can improve right ventricular function.