肺动脉瓣置换术治疗法乐四联症术后合并重度肺动脉瓣反流的结果分析  

Efficacy of Pulmonary Valve Replacement for the Treatment of Severe Pulmonary Regurgitation After Complete Repair Surgery in Patients With Tetralogy of Fallot

作　　者：陈求名 杨克明[1] 张浩[1] 花中东[1] 林野[1] 高华炜[1] 马凯[1] 张森[1] 祁磊[1] 王官玺 何凤璞 李守军[1] CHEN Qiu-ming, YANG Ke-ming, ZHANG Hao, HUA Zhong-dong, LIN Ye, GAO Hua-wei, MA Kai, ZHANG Sen, QI Lei, WANG Guan-xi, HE Feng-pu, LI Shou-jun(Pediatric Cardiac Surgery Center, National Center for Cardiovascular Diseases and FuWai Hospital, CAMS and PUMC, Beijing（100037）, China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院小儿心脏外科中心,北京市100037

出　　处：《中国循环杂志》2018年第7期671-676,共6页Chinese Circulation Journal

基　　金：首都临床特色应用研究(Z141107002514002)

摘　　要：目的:探索肺动脉瓣置换术(PVR)治疗法乐四联症矫治术后合并重度肺动脉瓣反流的效果。方法:回顾性分析2014-01至2017-02在我院行外科PVR治疗法乐四联症术后合并肺动脉瓣大量反流的24例患者的临床结果。结果:24例患者PVR手术时年龄(24.4±12.6)岁,患者行PVR与行法乐四联症矫治手术的平均间隔时间为(14.6±7.3)年。(1)围手术期结果:平均体外循环时间(182.5±75.4)min,平均主动脉阻断时间为(109.8±44.6)min(n=18,75%);同期三尖瓣成形10例(41.7%),瓣膜置换包括12例同种瓣,12例生物瓣。(2)手术结果:无院内死亡,平均住院时间为(15.2±5.5)天。(3)随访:平均随访(1.1±0.8)年,出院后无死亡及再手术等重大并发症,1例肺动脉瓣功能衰竭。PVR后右心室容积显著减小[手术前后右心室舒张末期容积指数:(190.5±29.8)ml/m2 vs(109.2±19.0)ml/m2,P<0.001;右心室收缩末期容积指数:(135.3±28.5)ml/m2 vs(80.0±11.3)ml/m2,P<0.001],而左心室容积、左心室射血分数、峰值耗氧量、QRS间期等改变差异均无统计学意义。末次随访超声检查发现,三尖瓣中量反流4例,肺动脉瓣大量反流1例、中量反流4例。结论:PVR可有效缩小法乐四联症矫治术后患者扩张的右心室,提高最大运动负荷,远期仍需进一步随访。Objectives： To investigate the clinical outcomes of pulmonary valve replacement（PVR） for patients with severe pulmonary regurgitation after TOF repair surgery.Methods： A retrospective review of all patients with severe pulmonary regurgitation after TOF repair who underwent PVR from January 2014 to February 2017 in our center was conducted. All patients were preoperatively evaluated by cardiovascular magnetic resonance and cardiopulmonary exercise test. The medical records and imaging results were analyzed.Results： A total of 24 patients underwent PVR with the age of（24.4 ± 12.6） years. The mean interval from total correction of TOF to PVR was（14.6±7.3）years. The initial age of TOF repair was（9.8±12.0） years. Mean cardiopulmonary bypass time and cross-clamp time（n=18） were（182.5±75.4） minutes and（109.8±44.6） minutes, respectively. Concomitant tricuspid annuloplasty was performed in 10 patients（41.7%）. Valve type for PVR included homograft（n=12） and bioprostheticpulmonary valve（n=12）. There was no early death. The mean length of hospital stay was（15.2 ± 5.5） days. The median duration of follow-up was 1.1 years and all patients completed the follow-up. There was no death and reoperation during follow-up, but pulmonary valve dysfunction was evidenced in one patient. PVR was related to a significant reduction in RV end-diastolic volume index（[109.2 ± 19.0]ml/m2 vs [190.5 ± 29.8]ml/m2, P 0.0001） and RV end-systolic volume index（[80.0 ± 11.3]ml/m2 vs [135.3 ± 28.5]ml/m2, P 0.001）, but did not improve RV ejection fraction. There was no significant change in left ventricle volume and ejection fraction, peak VO2 and QRS duration post PVR. Moderate tricuspid regurgitation was evidenced in 4 patients, severe pulmonary regurgitation in 1 patient and moderate pulmonary regurgitation in 4 patients at the latest echocardiography examination. Conclusions： In patients with severe pulmonary regurgitation after repair of TOF, PVR is a clinical beneficial and safe

关 键 词：法乐四联症 肺动脉瓣反流 肺动脉瓣置换 

分 类 号：R541.4[医药卫生—心血管疾病]