法洛四联症术后肺瓣膜置换术的围手术期处理及预后：一项回顾性研究

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports Pub Date : 2025-05-03 DOI:10.1016/j.ijscr.2025.111406

Chiaki Aichi, Keiichi Itatani, Yosuke Nakai, Takumi Kawase, Jiryo Haibara, Satoki Ozoe, Hisao Suda

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引用次数: 0

摘要

虽然法洛四联症（TOF）修复的长期预后良好，但随访期间对肺瓣膜功能不全的干预频率仍然很高，引起了对其侵袭性的担忧。本研究旨在评估TOF修复后肺动脉瓣干预的围手术期管理的安全措施和策略。方法自2022年11月至2023年12月，对17例TOF患者进行肺动脉介入治疗；对所有患者进行回顾性分析。所有病例术前均采用4d血流磁共振成像进行血流动力学评估。结果纳入研究的17例患者平均年龄24.1±14岁。从修复到再次干预的平均时间为18.2±12年，术前右心室射血分数为42.3±12%。平均手术时间为389±96 min，体外循环时间为210±67 min，主动脉交叉夹持时间为106±48 min。在8例患者中进行了肺动脉瓣置换术，其中7例使用猪主动脉瓣，1例使用牛心包瓣。9例患者采用rastelli型手术，其中7例使用膨胀聚四氟乙烯带瓣导管，2例使用猪生物假体瓣膜和Valsalva移植物的复合移植物。其他手术包括9例右心室流出道肌切除术，5例肺动脉重建，4例冷冻消融，3例冠状动脉旁路移植术，3例三尖瓣修复，1例室间隔缺损闭合。30天内无早期死亡、中风或再手术病例。结论通过适当的围手术期处理，对TOF术后肺动脉瓣进行干预是安全的。手术肺动脉瓣置换术的主要目的是保留右心室功能，重建从右心室到肺动脉的畅通通道，同时考虑到未来的经导管介入治疗。需要进一步的长期随访来评估预后，如远期死亡率、右心室功能和心律失常发生率。

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Perioperative management and outcomes of surgical pulmonary valve replacement following tetralogy of fallot repair: A retrospective study

Background

While the long-term prognosis of Tetralogy of Fallot (TOF) repair is favourable, the frequency of interventions for pulmonary valve insufficiency during follow-up remains high, raising concerns regarding its invasiveness. This study aimed to evaluate the safety measures and strategies for the perioperative management of pulmonary valve interventions following TOF repair.

Methods

From November 2022 to December 2023, interventions in the pulmonary artery for TOF were performed in 17 patients; a retrospective analysis was conducted on all patients. Preoperative haemodynamic evaluation was performed using 4D-flow magnetic resonance imaging in all cases.

Results

The 17 patients included in the study had a mean age of 24.1 ± 14 years. The mean duration from repair to re-intervention was 18.2 ± 12 years, with a preoperative right ventricular ejection fraction of 42.3 ± 12 %. The mean surgical time, cardiopulmonary bypass time, and aortic cross-clamp time were 389 ± 96, 210 ± 67, and 106 ± 48 min, respectively. Pulmonary valve replacement was performed in eight patients, with seven using porcine aortic valves and one using a bovine pericardial valve. The Rastelli-type procedure was performed in nine cases, with seven using expanded polytetrafluoroethylene valved conduits and two using composite grafts of a porcine bioprosthetic valve and Valsalva graft. Additional procedures included right ventricular outflow tract myectomy in nine patients, pulmonary artery reconstruction in five, cryoablation in four, coronary artery bypass grafting in three, tricuspid valve repair in three, and ventricular septal defect closure in one. There were no cases of early mortality, stroke, or re-operation within 30 days.

Conclusion

Interventions on the pulmonary valves following TOF repair can be safely performed with appropriate perioperative management. The primary goal of surgical pulmonary valve replacement is to preserve the right ventricular function and reconstruct a smooth pathway from the right ventricle to the pulmonary artery, considering future transcatheter interventions. Further long-term follow-up is necessary to assess outcomes, such as remote mortality, right ventricular function, and arrhythmia occurrence.

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