摘要
应用自行采集和冷冻保存的同种带瓣大动脉（ＶＨＣ）为５０例复杂先心病病儿重建右室流出道，观察其疗效及存在的问题。本组５０例，年龄１４个月～１６岁（５．９±３．２岁）。包括１７例完全性大动脉错位、７例右室双出口、５例永存动脉干和２１例法乐四联症。主动脉ＶＨＣ应用于４２例（裁剪成２瓣ＶＨＣ４例），肺动脉ＶＨＣ应用于２例，单瓣肺动脉作为补片扩大ＲＶＯＴ５例，同种无名动脉架桥于ＲＶＯＴ１例。结果：术后住院死亡７例。３５例随访１个月～７年，晚期死亡２例，均为感染。１例ＩＩ型ＰＴＡ病儿术后３年半发生心内膜炎，手术清除ＶＨＣ瓣膜处赘生物，仍存活。３３例长期生存者中５例Ｘ线胸片示ＶＨＣ有钙化，均为主动脉材料，仅１例有轻度压力阶差。结论：ＶＨＣ可广泛应用于复杂先心病。ＶＨＣ的长期通畅比合成管道好，肺动脉ＶＨＣ优于主动脉ＶＨＣ。为预防植入后ＶＨＣ的感染，应重视和改进ＶＨＣ的收集。
Aim:To review the experience of surgical results of reconstruction of right ventricular outflow tract using cryopreserved valved homograft conduit(VHC).Clinical material and method:Fifty patients with complex congenital heart disease were treated surgically from November 1989 to January 1996.The mean age of patients was 5.9±3.2 years(range,14 months to 16 years).The mean body weight was 16.9±6.1kg(range,7 to 31.5kg).The cardiac abnormalities consisted of transposition of the great arteries in 17 cases,Tetralogy of Fallot in 21,doubleoutlet right ventricule in 7 and truncus arterosus in 5.The radical operations were performed in 46 patients and palliative procedures in 4.VHC was implanted in 50 patients to enlarge the right ventricular outflow tract,including 42 aortic VHC,2 pulmonary VHC,5 single valved pulmonary homograft and 1 innominatal artery homograft.Results:The operative mortality rate was 14%(7/50)and two late deaths occurred.35 patients were followed up for a period of 1 month to 7 years.In 33 survivors,5 patients developed calcification of aortic VHC but only one patient had mild pressure gradient(60mmHg)cross conduit.Conclusion:The VHC can apply extensively for complex heart disease.The followup data has improved that the VHC is better than synthetic conduit,the pulmonary VHC is superior to aortic VHC.It is important to improve and modify the technique of collection and preservation of VHC.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
1998年第4期205-207,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
