法洛四联症根治术中肺动脉瓣成形术的临床应用  

Clinical application of pulmonary artery valvuloplasty with repaired tetralogy of fallot

作　　者：王正清[1] 靖文斌[1] 刘立新[1] 张嵬[1] 张建亮[1] 刘晓程[1] 

机构地区：[1]天津医科大学心血管病临床学院 泰达国际心血管病医院心外科,300457

出　　处：《中国综合临床》2011年第6期623-625,共3页Clinical Medicine of China

摘　　要：目的探讨法洛四联症术中肺动脉瓣成形术在右心室流出道（RVOT）重建术中的应用效果。方法法洛四联症矫治术93例患者中，行心包补片加宽RVOT及肺动脉瓣环同时肺动脉瓣成形术49例（A组），行心包补片加宽RVOT及肺动脉瓣环44例（B组）。术后超声测量肺动脉瓣返流指数（PRi）及返流束宽与肺动脉瓣环直径比值。结果术后随访（3．1±0．2）年，A组PRi和肺动脉瓣返流束宽与肺动脉瓣环直径比值优于B组[分别为0．55±0．13与0．61±0．10，t=2．685，P〈0．01；（52．0±10．4）％与（57．1±10．5）％，t=2．349，P〈0．05]，差异有统计学意义。三维超声显示A组69％（34／49）的成形肺动脉瓣发育为比较好的瓣叶。结论法洛四联症中扩大肺动脉瓣环同时行肺动脉瓣成形术可以减轻肺动脉瓣返流，取得满意的手术疗效。Objective To discuss clinic effect of pulmonary artery valvuloplasty for right ventricle outflow tract （RVOT） reconstruction in patients with repaired tetralogy of fallot （TOF）. Methods A total of 93 cases TOF were randomly divided into Group A （ n = 49 ） or Group B （ n = 44 ） to perform the procedure with repaired tetralogy of fallot. Group A received autogenous pericardium to enlarge RVOT and pulmonary valvuloplasty. Group B received autogenous pericardium to enlarge RVOT by routine therapy. Pulmonary regurgitation index（PRi） and the ratio between pulmonary regurgitant jet width and pulmonary annulus diameter were measured with echoeardiography. Results The mean follow-up was 3.1±0. 2 years. The PRi and the ratio between pulmonary regurgitant jet width and pulmonary annulus diameter in Group A were significantly lower than Group B （0.55±0.13 vs. 0.61±0.10,t =2.685,P〈0.01） and （[52.0±10.41% vs. [57.1±10. 5]% ,t = 2. 349, P 〈 0. 05 ） . Three-dimensional ultrasound examination showed that 69% （ 34/69 ） of pulmonary valves in Group A was developed well. Conclusion Pulmonary valvuloplasty during transannular patch for repaired TOF may prevent free pulmonary regurgitation and can obtain good clinical outcome.

关 键 词：法洛四联症 右心室流出道重建 肺动脉瓣成形 超声心动图 

分 类 号：R654.2[医药卫生—外科学]