目的探讨经皮肺动脉瓣球囊成形术(PBPV)处理法乐四联症(TOF)根治术后残余右室流出梗阻(RVOTO)的可行性及临床价值。方法2006年3月～2008年3月,我院共有5例TOF术后残余RVOTO的患者接受了PBPV术,其中男2例,女3例,年龄5～24岁,3例为残余肺...目的探讨经皮肺动脉瓣球囊成形术(PBPV)处理法乐四联症(TOF)根治术后残余右室流出梗阻(RVOTO)的可行性及临床价值。方法2006年3月～2008年3月,我院共有5例TOF术后残余RVOTO的患者接受了PBPV术,其中男2例,女3例,年龄5～24岁,3例为残余肺动脉瓣狭窄,2例为残余肺动脉瓣下狭窄,所有患者均经股静脉途径采用聚乙烯单球囊法或Inoue球囊法进行PBPV术,介入治疗前后测量肺动脉-右室峰值压差。所有患者介入术后24 h、3个月、6个月复查超声心动图、心电图进行随访。结果5例患者PBPV术均获成功,右室-肺动脉峰值压差平均由术前的61 mm Hg下降至9.6 mm Hg,无严重并发症发生,平均随访7.2个月(平均3～12个月),无再狭窄发生。结论TOF外科根治术后残余RVOTO中的部分病例,可采用PBPV术有效解除梗阻,避免二次手术的风险。展开更多
Baekground Although a lot of studies have been performed on the long term outcome in adults with repaired tetralogy of Fallot （TOF） in developed countries, but rare information for primary correction of adult TOF is...Baekground Although a lot of studies have been performed on the long term outcome in adults with repaired tetralogy of Fallot （TOF） in developed countries, but rare information for primary correction of adult TOF is available. The research focusing on the effect of transanular patch （TAP） for primary correction of TOF in adulthood is still absent. Via retrograde analysis of 7-year follow-up, this study was designed to explore the effect of the transanular patch for primary correction in adult TOF on the surgical outcome, postoperative cardiac function and morbidity, as well as to address the management of the complication. Methods A total of 151 consecutive adult patients （age ≥ 18） who underwent primary radical correction of TOF form 2007-2014 were selected and divided into TAP demographic statistic characteristics, and non-TAP groups based on the EACTS database. Results of echocardiography, color-Doppler echocardiography, cardiovascular enhanced contrast computed tomography （CT）, and/or cardiac catheterization; intraoperative information, postoperative results and outcomes were reported. During follow-up, short term was defined within 3 months after discharge, and midterm was defined as 6-12 months after discharge. Results Total postoperative mortality was 5.96% in all the cases, 6.96% in TAP group, and 2.78% （1/36） in non-TAP group. There was no significant difference between two groups. Follow-up period ranged from 3 months to 62 months. Readmission occurred and was followed by medical treatment without re-do surgery in 6 cases （3.97%）. The short term echocardiography demonstrated that pulmonary regurgitation and short term tricuspid regurgitation after discharge in TAP group were more severe （P 〈 0.001）. The short term residual pulmonary stenosis （RVOTO） severity after discharge in TAP group was less severe （P = 0.018）. Midterm echocardiography after discharge demonstrated pulmonary regurgitation and tricuspid regurgitation in TAP group were still more severe （P = 0.展开更多
文摘目的探讨经皮肺动脉瓣球囊成形术(PBPV)处理法乐四联症(TOF)根治术后残余右室流出梗阻(RVOTO)的可行性及临床价值。方法2006年3月～2008年3月,我院共有5例TOF术后残余RVOTO的患者接受了PBPV术,其中男2例,女3例,年龄5～24岁,3例为残余肺动脉瓣狭窄,2例为残余肺动脉瓣下狭窄,所有患者均经股静脉途径采用聚乙烯单球囊法或Inoue球囊法进行PBPV术,介入治疗前后测量肺动脉-右室峰值压差。所有患者介入术后24 h、3个月、6个月复查超声心动图、心电图进行随访。结果5例患者PBPV术均获成功,右室-肺动脉峰值压差平均由术前的61 mm Hg下降至9.6 mm Hg,无严重并发症发生,平均随访7.2个月(平均3～12个月),无再狭窄发生。结论TOF外科根治术后残余RVOTO中的部分病例,可采用PBPV术有效解除梗阻,避免二次手术的风险。
基金supported by The Twelfth National Five-Year Plan(No.2011BAI11B22)
文摘Baekground Although a lot of studies have been performed on the long term outcome in adults with repaired tetralogy of Fallot （TOF） in developed countries, but rare information for primary correction of adult TOF is available. The research focusing on the effect of transanular patch （TAP） for primary correction of TOF in adulthood is still absent. Via retrograde analysis of 7-year follow-up, this study was designed to explore the effect of the transanular patch for primary correction in adult TOF on the surgical outcome, postoperative cardiac function and morbidity, as well as to address the management of the complication. Methods A total of 151 consecutive adult patients （age ≥ 18） who underwent primary radical correction of TOF form 2007-2014 were selected and divided into TAP demographic statistic characteristics, and non-TAP groups based on the EACTS database. Results of echocardiography, color-Doppler echocardiography, cardiovascular enhanced contrast computed tomography （CT）, and/or cardiac catheterization; intraoperative information, postoperative results and outcomes were reported. During follow-up, short term was defined within 3 months after discharge, and midterm was defined as 6-12 months after discharge. Results Total postoperative mortality was 5.96% in all the cases, 6.96% in TAP group, and 2.78% （1/36） in non-TAP group. There was no significant difference between two groups. Follow-up period ranged from 3 months to 62 months. Readmission occurred and was followed by medical treatment without re-do surgery in 6 cases （3.97%）. The short term echocardiography demonstrated that pulmonary regurgitation and short term tricuspid regurgitation after discharge in TAP group were more severe （P 〈 0.001）. The short term residual pulmonary stenosis （RVOTO） severity after discharge in TAP group was less severe （P = 0.018）. Midterm echocardiography after discharge demonstrated pulmonary regurgitation and tricuspid regurgitation in TAP group were still more severe （P = 0.
