CAJ | 학술논문

目的：评价膨体聚四氟乙烯片(Gore-Tex 片)作肺动脉单瓣重建右室流出道(RVOT)的近期疗效。方法2002年6月至2013年6月对91例先天性心脏病合并肺动脉狭窄或闭锁的患者施行矫治手术,其中男51例,女40例。法洛四联症合并肺动脉狭窄67例,法洛四联症合并Ⅰ型肺动脉闭锁12例,法洛四联症合并肺动脉瓣缺如5例,右心室双出口合并肺动脉狭窄3例,完全大动脉转位2例,肺动脉狭窄及室间隔缺损各1例。结果术中采用厚度0.1 mm 的 Gore-Tex 片作肺动脉单瓣的Dacron 血管片重建 RVOT,术后血氧饱和度为96%~100%,动脉血氧分压82~207 mmHg,右室/左室收缩压比值0.22~0.70,右室与左、右肺动脉间的压力阶差小于10 mmHg。左室射血分数0.53~0.80,右室射血分数0.52~0.71,左室舒张末期容积指数0.28~0.62 ml/ m2。术后早期并发症：心包积液10例,低氧血症(氧合指数﹤150)8例,心律失常7例,低心排血量综合征5例,残余室间隔缺损4例。术后随访3~48个月,无死亡和并发症的发生,其中76例 RVOT 早期瓣膜活动功能正常,15例单瓣固定在开放状态；87例无肺动脉单瓣狭窄,4例单瓣轻度狭窄；23例肺动脉瓣轻度反流,6例中度反流。结论采用厚度0.1 mm 的 Gore-Tex 片作单瓣重建 RVOT,可获得满意的临床和血流动力学效果,近期效果良好。
목적：평개팽체취사불을희편(Gore-Tex 편)작폐동맥단판중건우실류출도(RVOT)적근기료효。방법2002년6월지2013년6월대91례선천성심장병합병폐동맥협착혹폐쇄적환자시행교치수술,기중남51례,녀40례。법락사련증합병폐동맥협착67례,법락사련증합병Ⅰ형폐동맥폐쇄12례,법락사련증합병폐동맥판결여5례,우심실쌍출구합병폐동맥협착3례,완전대동맥전위2례,폐동맥협착급실간격결손각1례。결과술중채용후도0.1 mm 적 Gore-Tex 편작폐동맥단판적Dacron 혈관편중건 RVOT,술후혈양포화도위96%~100%,동맥혈양분압82~207 mmHg,우실/좌실수축압비치0.22~0.70,우실여좌、우폐동맥간적압력계차소우10 mmHg。좌실사혈분수0.53~0.80,우실사혈분수0.52~0.71,좌실서장말기용적지수0.28~0.62 ml/ m2。술후조기병발증：심포적액10례,저양혈증(양합지수﹤150)8례,심률실상7례,저심배혈량종합정5례,잔여실간격결손4례。술후수방3~48개월,무사망화병발증적발생,기중76례 RVOT 조기판막활동공능정상,15례단판고정재개방상태；87례무폐동맥단판협착,4례단판경도협착；23례폐동맥판경도반류,6례중도반류。결론채용후도0.1 mm 적 Gore-Tex 편작단판중건 RVOT,가획득만의적림상화혈류동역학효과,근기효과량호。
Objective To evaluate the short term efficacy of reconstruction of right ventricular outflow tract(RVOT)with 0. 1 mm Gore-Tex monocusp valve. Methods From June 2002 to June 2013,91 patients (51 males,40 females) underwent reconstruction of RVOT with Gore-Tex monocusp valve to correct cardiac anomalies were enrolled,including 67 patients with tetralogy of Fallot(TOF)and pulmonary stenosis, 12 patients with TOF and pulmonary atresia,5 patients with TOF and absent pulmonary valve, 3 patients with double outlet of right ventricle and pulmonary stenosis,2 patients with complete transposition of great artery and 1 patient with ventricular septal defect and pulmonary stenosis. Results There was no operative death. The postoperative blood oxygen saturation was up to 96% - 100%. PaO2 was 82 - 207 mmHg. The ratios of right ventricular systolic pressure and left ventricular systolic pressure were between 0. 22 and 0. 70. The gradient pressure between right ventricle and left or right pulmonary artery was less than 10 mmHg. Left ventricular ejection fraction (LVEF) was 0. 53 - 0. 80, right ventricular ejection fraction (RVEF) was 0. 52- 0. 71, left ventricular end-diastolic volume index was 0. 28 - 0. 62 ml/ m2. Early postoperative complications were present: pericardial effusion in 10 cases, hypoxemia ( oxygenation index ﹤ 150) in 8 cases, arrhythmia in 7 cases, low cardiac output syndrome in 5 cases and 4 cases of residual ventricular septal defects. All patients were followed up by echocardiography ranging from 3 to 48 months after the surgery. There were no death and complications. The 76 patients had normal valve active functions, 15 patients had single cusp fixed in the open state; 87 patients had no pulmonary stenosis, 4 patients had mild stenosis; 23 patients had mild pulmonary valve regurgitation, 6 patients had moderate regurgitation. Conclusions These results demonstrate that the surgical reconstruction of RVOT with 0. 1 mm Gore-Tex monocusp valve could have satisfied clinical and hemodynamic effects in short term.