活性同种带瓣主动脉补片重建法乐四联症右室流出道  

Application of Cryopreserved Viable Aortic Homografts for Reconstruction of Right Ventricular Outflow Tract in Tetralogy of Fallot

作　　者：王吉秋[1,2] 荣佑宝[1,2] 崔向东[1,2] 徐平[1,2] 王志斌[1,2] 

机构地区：[1]青岛医学院附属第一医院 [2]青岛市市立医院心胸外科

出　　处：《中华胸心血管外科杂志》1998年第6期334-336,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：山东省科委资金

摘　　要：为评价活性同种主动脉（ＣＶＡＨ）补片重建法乐四联症（ＴＯＦ）右室流出道（ＲＶＯＴ）的临床效果。以保留无冠瓣及二尖瓣大瓣的ＣＶＡＨ重建ＲＶＯＴ４０例。关胸前测定各心腔压力并行彩色多普勒超声随访。结论：关胸前测压，ＣＶＡＨ组与对照组右室收缩压／左室收缩压（ＲＶＳＰ／ＬＶＳＰ）分别为０．４９±０．０９和０．６２±０．１３（ｔ＝４．８０，Ｐ＜０．００１）；ＲＶＳＰ分别为６．３０±１．３６ｋＰａ和７．８８±２．３４ｋＰａ（ｔ＝３０．７７，Ｐ＜０．００１）；右室—肺动脉压力阶差（ＲＶ—ＰＡＰＧ）分别为０．９７±０．７９ｋＰａ和３．２９±１．９７ｋＰａ（ｔ＝６．６９，Ｐ＜０．００１）；中心静脉压（ＣＶＰ）分别为１．３２±０．２４ｋＰａ和２．０６±０．５１ｋＰａ（ｔ＝８．２１，Ｐ＜０．００１）。ＣＶＡＨ组血流动学力效果明显优于对照组。ＣＶＡＨ组手术死亡１例（２．５％），余３９例全部随访２８．３±１８．１（６～６６）个月，无远期死亡，心功能恢复优良。多普勒超声显示术后肺动脉反流轻微，ＣＶＡＨ无失功及钙化。结论：带瓣ＣＶＡＨ是理想的ＲＶＯＴ重建材料，血流动力学效果优良，可以最大限度加宽ＲＶＯＴ和减轻肺动脉反流。Aim:To examine the clinical effects of reconstruction of right ventricular outfolow tract(RVOT)with cryopreserved viable aortic homografts(CVAH)in tetralogy of Fallot(TOF).Clinical material and method:Forty patients with TOF underwent surgical correction and RVOT was reconstructed using CVAH(CVAH group).There were 25 men and 15 women with a mean age of 9.8 years(range,3.5 to 20 years).Another 26 patients with TOF underwent reconstruction of RVOT using pericardium(control group).The results of two groups were compared.Result:In CVAH group,there was one operative death,an operative mortality rate of 2.5%.The mean follow up time was 28 months(range,6～66 months).Cardiac function was improved significantly in all survived patients. Comparing with the control group,the hemodynamic results,including right ventricular systolic pressure,left ventricular systolic pressure,right ventricular diastolic pressure,right ventricular pulmonary artery pressure gradient and central venous pressure,were much better in CVAH group.No calcification and dysfunction of CVAH so far were found.Conclusion:The results of this study suggest that RVOT reconstruction with CVAH can yield excellent clinical outcome.The CVAH is an ideal material for RVOT reconstruction.

关 键 词：冷冻保存 法乐氏四联症 CVAH RVOT 同种移植 

分 类 号：R654.2[医药卫生—外科学]