中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

右室流出道重建术治疗复杂先天性心脏病的临床研究—单中心 10 年随访分析

查看全文

目的 总结分析多种右心室流出道手术治疗复杂性先天性心脏病(先心病)的临床经验。 方法 回顾性分析 2007 年 1 月至 2017 年 1 月我院胸外科共收治 3 138 例右心系统复杂性先心病患儿的临床资料,其中男 1 660 例、女 1 478 例,手术年龄 9 d~84 个月,体质量 2.2~28.6 kg。所有患儿均完成右心室流出道重建术,手术方法包括肺动脉补片扩大术 2 335 例,自体组织连接右心室 289 例,外管道重建右室流出道例 514 例。 结果 术后早期死亡 186 例(5.9%),死亡原因主要为严重低心排血量综合征,肺高压危象及右心衰。中远期死亡 5 例(术后 6~27 个月),死亡原因主要为心功能不全和突发猝死。术后共随访 2 782 例患儿,中远期随访结果:右心室流出道梗阻 408 例,肺动脉及分支狭窄 340 例,中度以上肺动脉瓣反流 309 例。394 例患儿实施二次手术,再手术率为 12.6%,术后死亡 39 例,死亡率为 9.9%。随访过程中,90% 以上患儿心功能恢复良好,纽约心功能分级(NYHA)达到Ⅱ级以上。 结论 右心室流出道覆盖范围广,解剖结构复杂多变,手术方法多样,且各具优势,中远期预后均较满意。手术方案应根据病变类型、解剖特点,临床症状以及手术条件等多方面因素进行个体化制定。

Objective The purpose of this report was to assess the mid- and long-term outcomes of right ventricular outflow tract reconstruction for children with congenital heart disease. Method We retrospectively analyzed the clinical data of 3 138 children with right heart system complicated congenital heart disease admitted to our hospital from January 2007 to January 2017. There were 1 660 males and 1 478 females. The age of surgery was 9 days to 84 months, and the body weight was 2.2 to 28.6 kg. Pulmonary patch enlargement was performed in 2 335 patients (1477 patients of valve-sparing repair and 858 patients of transannular repair); autologous tissue (direct anastomosis, left auricle or pericardial conduit) was used to connect with right ventricle in 289 patients; extracardiac conduits were used for reconstruction in 514 patients. Result There were 186 in-hospital deaths with a mortality of 5.9%. The early postoperative causes of death were low cardiac output syndrome (LCOS), severe pulmonary hypertension and right heart failure. 5 patients died of cardiac insufficiency or sudden death during follow-up (6–27 months later). The echocardiography showed 408 patients with right ventricular outflow tract obsturction (RVOTO), 340 patients with pulmonary trunk or branches stenosis, 609 with pulmonary regurgitation (morderate or severe). 12.6% (394/3 138) of patients underwent reintervention or reoperation with 39 deaths. More than 90% patients exhibited an improvement of NYHA functional class from Ⅲ or Ⅳ preoperatively to Ⅰ or Ⅱ at follow-up. Conclusion The anatomical structure of right ventricular outflow tract is complicated and various, and each operation method has different strengths and favorable outcomes. The operation should be individually designed according to pathological types, anatomical features, clinical symptoms and operation conditions.

关键词: 复杂性先天性心脏病; 右心室流出道重建术; 自体组织; 外管道;  

Key words: Congenital heart disease; right ventricular outflow tract reconstruction; reconstructional pulmonary valve; autologous tissue; Extracardiac conduit

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. He GW. Current strategy of repair of tetralogy of Fallot in children and adults: emphasis on a new technique to create a monocusp-patch for reconstruction of the right ventricular outflow tract. J Card Surg, 2008, 23(6): 592-599.
2. Sasikumar N, Ramanan S, Rema K M, et al. Prosthetic reconstruction of bicuspid pulmonary valve in tetralogy of Fallot. Asian Cardiovasc Thorac Ann, 2014, 22(4): 436-441.
3. Lee C, Lee C H, Kwak J G, et al. Bicuspid pulmonary valve implantation using polytetrafluoroethylene membrane: early results and assessment of the valve function by magnetic resonance imaging. Eur J Cardiothorac Surg, 2013, 43(3): 468-472.
4. Sasson L, Houri S, Raucher S A, et al. Right ventricular outflow tract strategies for repair of tetralogy of Fallot: effect of monocusp valve reconstruction. Eur J Cardiothorac Surg, 2013, 43(4): 743-751.
5. Pande S, Sharma JK, Siddartha CR, et al. Fresh autologous pericardium to reconstruct the pulmonary valve at the annulus when tetralogy of fallot requires a transannular patch at midterm. Tex Heart Inst J, 2016, 43(3): 207-213.
6. Isomatsu Y, Shin'Oka T, Aoki M, et al. Establishing right ventricle-pulmonary artery continuity by autologous tissue: an alternative approach for prosthetic conduit repair. Ann Thorac Surg, 2004, 78(1): 173-180.
7. Gerelli S, Van S M, Murtuza B, et al. Neonatal right ventricle to pulmonary connection as a palliative procedure for pulmonary atresia with ventricular septal defect or severe tetralogy of Fallot. Eur J Cardiothorac Surg, 2014, 45(2): 278-288.
8. Luo K, Zheng J, Zhu Z, et al. Outcomes of right ventricular outflow tract reconstruction for children with persistent truncus arteriosus: a 10-year single-center experience. Pediatr Cardiol, 2017, 39(12): 1-10.
9. Ong K, Boone R, Gao M, et al. Right ventricle to pulmonary artery conduit reoperations in patients with tetralogy of fallot or pulmonary atresia associated with ventricular septal defect. Am J Cardiol, 2013, 111(11): 1638-1643.
10. 胡小松, 杨克明, 李守军, 等. 同种带瓣管道用于右心室流出道重建的中期效果. 中国循环杂志, 2016, 31(4): 385-388.
11. Schiller O, Sinha P, Zurakowski D, et al. Reconstruction of right ventricular outflow tract in neonates and infants using valved cryopreserved femoral vein homografts. J Thorac Cardiovasc Surg, 2014, 147(3): 874-879.
12. Kumar TK, Bricenomedina M, Sathanandam S, et al. Femoral Vein Homograft as Right Ventricle to Pulmonary Artery Conduit in Stage 1 Norwood Operation. Ann Thorac Surg, 2017, 103(6): 1969-1974.
13. Fiore AC, Ruzmetov M, Huynh D, et al. Comparison of bovine jugular vein with pulmonary homograft conduits in children less than 2 years of age. Eur J Cardiothorac Surg, 2010, 38(3): 318-325.
14. Prior N, Alphonso N, Arnold P, et al. Bovine jugular vein valved conduit: up to 10 years follow-up. J Thorac Cardiovasc Surg, 2011, 141(4):983-987.
15. Sandica E, Boethig D, Blanz U, et al. Bovine jugular veins versus homografts in the pulmonary position: an analysis across two centers and 711 patients-conventional comparisons and time status graphs as a new approach. Thorac Cardiovasc Surg, 2015, 64(01):25-35.
16. Ugaki S, Rutledge J, Al A M, et al. An Increased Incidence of Conduit Endocarditis in Patients Receiving Bovine Jugular Vein Grafts Compared to Cryopreserved Homograft for Right Ventricular Outflow Reconstruction. Ann Thorac Surg, 2015, 99(1):140-146.
17. Takahashi Y, Tsutsumi Y, Monta O, et al. Expanded polytetrafluoroethylene-valved conduit with bulging sinuses for right ventricular outflow tract reconstruction in adults. Gen Thorac Cardiovasc Surg, 2010, 58(1):14-18.
18. Shinkawa T, Tang X, Gossett J M, et al. Valved polytetrafluoroethylene conduits for right ventricular outflow tract reconstruction. Ann Thorac Surg, 2015, 100(1):129-137.
19. Shinkawa T, Chipman C, Bozzay T, et al. Outcome of right ventricle to pulmonary artery conduit for biventricular repair. Ann Thorac Surg, 2015, 99(4):1357-1366.
20. Yamashita E, Yamagishi M, Miyazaki T, et al. Smaller-sized expanded polytetrafluoroethylene conduits with a fan-shaped valve and bulging sinuses for right ventricular outflow tract reconstruction. Ann Thorac Surg, 2016, 102(4):1336-1344.