摘要
目的比较应用牛颈静脉带瓣管道与自体心包管道重建右心室流出道的中期疗效差异。方法回顾性分析2013年5月至2016年7月接受外管道重建右心室流出道术的18例先天性心脏病患者的临床资料,患者年龄为2~16(5.22±4.12)岁,男11例、女7例,肺动脉闭锁合并室间隔缺损7例、右心室双出口合并肺动脉瓣狭窄4例、永存动脉干3例、永存动脉干合并右肺动脉缺如1例、矫正型大动脉转位合并肺动脉瓣狭窄1例、完全大动脉转位合并肺动脉瓣狭窄2例。术中采用完整国产牛颈静脉带瓣管道重建右心室流出道11例(牛颈静脉管道组),采用自体心包管道重建右心室流出道7例(自体心包管道组),记录围手术期情况。术后随访4~56个月,应用心脏超声及心脏计算机断层扫描血管成像(CTA)评估疗效。结果牛颈静脉管道组11例患者无围手术期死亡;自体心包管道组7例患者死亡2例,其中1例死于术后肺动脉高压危象,1例死于低心排出量综合征。牛颈静脉管道组右心室压/桡动脉压比值、术后机械通气时间、重症监护病房(ICU)时间均小于自体心包管道组,差异均有统计学意义(P均<0.05);两组患者体外循环时间、主动脉阻闭时间、停机后右心室流出道跨瓣压差、输血量及住院总费用差异均无统计学意义(P均>0.05)。两组随访期间均无死亡病例,牛颈静脉管道组无再次手术病例,自体心包管道组1例因严重右心功能不全于术后2年行机械瓣膜带瓣管道植入术。超声测量结果显示,牛颈静脉管道组术后最后一次随访时右心室流出道跨瓣压差与出院前相比差异无统计学意义[(22.91±7.31)mmHg(1 mmHg=0.133kPa)vs(20.45±6.70)mmHg,P>0.05],自体心包管道组术后最后一次随访时右心室流出道跨瓣压差高于出院前[(29.20±18.09)mmHg vs(16.14±4.02)mmHg,P<0.05];牛颈静脉管道组术后最后一次随访时发现轻度反流8例、中度反流3例,自体心包管道�
Objective To compare the mid-term outcomes of valved bovine jugular vein conduit and autologous pericardium conduit in reconstruction of right ventricular outflow tract.Methods Eighteen congenital heart disease patients were implanted with external conduits(included 11 valved bovine jugular vein conduits and 7 autologous pericardium conduits)for right ventricular outflow tract reconstruction between May 2013 and Jul.2016.There were 11 males and 7 females at age of 2-16(5.22±4.12)years.Preoperative clinical diagnoses included pulmonary artery atresia with ventricular septal defect(n=7),double outlet of right ventricle with pulmonary stenosis(n=4),persistent truncus arteriosus(n=3),persistent truncus arteriosus with absence of right pulmonary artery(n=1),corrected transposition of great arteries with pulmonary stenosis(n=1),and transposition of great arteries with pulmonary stenosis(n=2).The perioperative status was recorded.The cardiac ultrasound and computed tomography angiography(CTA)were used to evaluate the efficacy during 4-56 months of follow-up.Results There were no perioperative deaths in the bovine jugular vein conduit group,and 2 deaths in the autologous pericardium conduit group.One died of pulmonary hypertension crisis and the other died of low cardiac output syndrome.The ratio of right ventricular pressure to radial arterial pressure,duration of mechanical ventilation and intensive care unit(ICU)stay after surgery were significantly lower in the bovine jugular vein conduit group than those in the autologous pericardium conduit group(all P<0.05).There were no significant differences in extracorporeal circulation time,aortic cross-clamping time,transvalvular gradient in right ventricular outflow tract,blood consumption or total hospitalization costs between the two groups(all P>0.05).During follow-up,there were no deaths in the two groups,no reoperations in the bovine jugular vein conduit group,and 1 case received reoperation 2 years after surgery due to severe right ventricular dysfunction in the auto
作者
林曦
王晓武
马涛
袁彬彬
张本
杨博
林钊明
张卫达
LIN Xi;WANG Xiao-wu;MA Tao;YUAN Bin-bin;ZHANG Ben;YANG Bo;LIN Zhao-ming;ZHANG Wei-da(Department of Cardiovascular Surgery,Guangzhou Clinical Medicine College (General Hospital of Southern Theater Command of PLA),Naval Medical University (Second Military Medical University),Guangzhou 510010,Guangdong,China)
出处
《第二军医大学学报》
CAS
CSCD
北大核心
2019年第6期624-629,共6页
Academic Journal of Second Military Medical University
基金
广东省医学科学技术研究基金(WSTJJ20111110)~~
关键词
右心室流出道重建术
牛颈静脉带瓣管道
自体心包管道
中期疗效
right ventricular outflow tract reconstruction
valved bovine jugular vein conduit
autologous pericardium conduit
mid-term outcomes
