应用膨体聚四氟乙烯(ePTFE)人工带瓣血管重建右心室流出道的Ross手术治疗儿童主动脉瓣疾病  

Ross procedure to cure aortic valve disease in children with expended polytetrafluoraethylene(ePTFE)artificial valve for right ventricular outflow tract reconstruction

作　　者：王鹏程 张程 梁穗新 孟保英[1] 刘怀普[1] 黄骏荣 吴文智 吴柯叶 丁以群[1] Wang Pengcheng;Zhang Cheng;Liang Suixin;Meng Baoying;Liu Huaipu;Huang Junrong;Wu Wenzhi;Wu Keye;Ding Yiqun(Department of Cardiothoracic Surgery,Shenzhen Children's Hospital,Shenzhen 518038,China)

机构地区：[1]深圳市儿童医院胸心外科,518038

出　　处：《中华胸心血管外科杂志》2021年第12期711-716,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：深圳市医学重点学科(SZXK036);深圳市三名工程(SZSM201612003);广东省医学科学技术研究基金(A2020204);广东省深圳市科创委基础研究面上项目(JCYJ20190809170811489)。

摘　　要：目的总结采用ePTFE人工带瓣血管构建右心室流出道的自体肺动脉瓣行主动脉瓣置换术(Ross手术)治疗儿童主动脉瓣狭窄和/或关闭不全的临床经验。方法回顾分析我中心2015年至2020年采用Ross手术治疗的8例主动脉瓣狭窄和/或关闭不全患儿的临床资料,年龄0.5~13.2岁,术前诊断主动脉瓣狭窄4例、主动脉瓣狭窄伴关闭不全3例、感染性心内膜炎累及主动脉瓣1例。手术主要分三步进行:获取自体肺动脉瓣;切除病变的主动脉瓣,采用主动脉根部移植法将自体肺动脉瓣移至主动脉瓣;利用手工缝制的ePTFE人工带瓣血管重建右心室流出道。结果6例右心室流出道采用手工缝制ePTFE人工带瓣血管重建,2例采用人工单瓣,无手术死亡,全部患者治愈出院。随访1~36个月,中位随访时间12个月,无远期死亡,无瓣膜相关并发症。随访超声心动图检查提示1例主动脉瓣中量反流,1例少-中量反流,其余为少量反流;肺动脉瓣中2例采用人工单瓣的少量反流,其余采用手工缝制的ePTFE人工带瓣血管肺动脉瓣少量反流或微量反流;所有患者末次随访主动脉瓣跨瓣峰值压差(6.63±3.46)mmHg(1 mmHg=0.133 kPa)。左心室流出道及主动脉瓣环在术后会稍缩小(1例Ross-Konno手术患者直径增大),但随着年龄的增长瓣环直径均呈增长趋势,目前暂无需要再次干预者。结论Ross手术用于治疗主动脉瓣膜疾病安全,血流动力学效果好,自体肺动脉具有生长潜能,尤其适用于儿童及年轻患者。用于重建右心室流出道的手工缝制ePTFE人工带瓣血管短期内抗反流功能良好,或可做为同种/异种带瓣管道替代材料,但仍需更长时间的随访及更多的病例积累。Objective To review and analyze the clinical experience of children with aortic valve stenosis and/or insufficiency treated with autologous pulmonary valve for aortic valve replacement procedure(Ross operation)with ePTFE artificial valve for right ventricular outflow tract reconstruction.Methods From 2015 to 2020,8 cases of aortic stenosis and/or aortic insufficiency treated by Ross operation in our center were collected,with an age of 0.5-13.2 years old.4 cases of aortic stenosis were diagnosed preoperatively,3 cases of aortic stenosis with aortic insufficiency,and 1 case of infective endocarditis involving the aortic valve.The operation was carried out in three steps:Harvest autologous pulmonary valve;the diseased aortic valve was resected and autologous pulmonary valve was transplanted to the aorta by aortic root transplantation;the right ventricular outflow tract was reconstructed by a handmade ePTFE artificial flap blood vessel.Results In 6 cases,the right ventricular outflow tract was reconstructed by hand-sewn ePTFE trileaflets,and artificial univalve in 2 cases,no death occurred during operation;all patients were cured and discharged.The patients were followed up for 1 to 36 months,with mean of(12.63±12.19)months.There was no long-term death or valvular complications.During follow-up echocardiography indicated 1 case of moderate aortic regurgitation,1 case of mild-moderate regurgitation,and moderate regurgitation was found in 2 patients with artificial single pulmonary valve.For the remaining patients,they were mild aortic regurgitation,and a trivial or mild pulmonary artery regurgitation with hand-sewn three-leaflets ePTFE artificial vessel;All patients were followed up at the last time with a peak pressure of(6.63±3.46)mmHg(1 mmHg=0.133 kPa)across the aortic valve.The left ventricular outflow tract and aortic annulus shrank slightly after surgery(the diameter of one patient with Ross-Konno operation increased),but the annulus diameter increased with age.There was no need for further intervention.Concl

关 键 词：主动脉瓣疾病 ROSS手术 儿童 ePTFE人工带瓣血管 

分 类 号：R726.5[医药卫生—儿科]