同种带瓣主动脉和肺动脉移植在复杂先心病治疗中的应用  

Clinical application of cryopreserve valved homograft conduit in complex congenital heart disease

作　　者：舒涛[1] 江泽熙[1] 杨楚墩[1] 舒龙[1] 皮名安[1] 林红[1] 

机构地区：[1]武汉市儿童医院胸心外科

出　　处：《临床外科杂志》2005年第2期108-110,i001,共4页Journal of Clinical Surgery

基　　金：武汉市科委攻关计划资助项目 (编号 :9860 0 52 2 3)

摘　　要：目的　研究同种带瓣主、肺动脉移植应用于复杂性先天性心脏病矫治的疗效。方法　制备同种带瓣管道 89根 (主动脉 5 5根、肺动脉 3 4根 ) ,临床应用 3 1例 ,其中主、肺动脉单瓣作右室流出道跨瓣补片术 14例 ,Rastelli手术 11例 ,右心室 -肺动脉连接 (RV -PA) 3例 ,肺动脉瓣置换1例 ,Ross手术 1例 ,改良Fantan手术 1例。结果　主、肺动脉单瓣作右室流出道跨瓣补片组 14例 ,1例术后 3d死于右心功能不全 ,存活 13例 ,随访 ( 4 3± 3 .2 )个月 ,超声心动图检查显示移植后瓣膜启闭功能良好 ,无增厚及粘连。复杂性先天心脏病矫治组 17例 ,死亡 7例 ,存活 10例 ,随访( 3 4.3± 6.3 9)个月 ,管道血流通过顺畅 ,管壁无变薄、钙化。结论　①同种带瓣管道具有管壁弹性好 ,易于缝合 ,术后排斥反应少等优点 ,可广泛应用于复杂性先天性心脏病矫治术 ,左、右室流出道的重建 ;②同种带瓣管道补片既能加宽右室流出道 ,且有良好抗返流作用 ,有利于术后患儿心功能恢复 。Objective To evaluate the results of clinical application of cryopreserved homograft in complex congenital heart disease.Methods Homograft bank has been established in our hospital.There were 55 aorta conduits and 34 pulmonary arteries to be preserved.Thirty-one patients with complex congenital heart disease were received cryopreserved valved homograft conduit transplantation(VHC).Monocusoid transannular patch was used in 14 patients.Rastelli operation was performed on 11 patients,right ventricular and pulmonary artery homograft on 3,modified Fontan operation on 1,Ross operation on 1,and pulmonary valve transplantation 1.The regular follow-up procedure has been consisted of physical examination and cardiovascular ultrasonography for three years.Results The Monocusoid transannular patch was used in 14 patients,one of them (7.14%) died of right ventricular failure three days post-operatively.The remaining 13 patients were followed-up for (43±3.2)(1～57) months with the grafted valves functional pretty well.VCH were used in 17 cases with complex heart disease.Seven (41.2%) died from various complications.The other 10 cases were alive and followed-up to (30.3±6.39)(9～57)months without calcium or degeneration of the graft under echocardiography examination.Conclusion (1)The satisfactory follow-up results of this series suggest that the homograft transplantation may be the first choice to replace the staged operations on complex congenital heart disease correction in children;(2)ROVT reconstruction with cryopreserved monocusoid transannular patch not only widens the outflow tract of the right ventricle,but also possesses the ability of anti-regurgitation.

关 键 词：先天性心脏病 同种带瓣管道 临床应用 

分 类 号：R726.5[医药卫生—儿科]