法洛四联症单瓣肺动脉瓣重建:二维超声心动图和3-T心脏MRI的早期结果和评价。

IF 0.6 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Sneha Daniel, Pranav Gupta, Kalpana Bansal, Arima Nigam, Saket Agarwal, Muhammed Abid Geelani
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引用次数: 0

摘要

背景:在法洛四联症(TOF)的心内修复中,经环补片(TAP)修复右心室流出道(RVOT)一直受到残留解剖和血流动力学异常的困扰,导致死亡率和发病率。虽然人们已经努力减轻TAP修复后游离性肺反流(PR)的影响,但没有一种方法显示出更好的效果。在本文中,我们尝试了一种新的单瓣肺动脉瓣重建方法,在单瓣边缘使用固定的自体心包条,并使用二维超声心动图和心脏磁共振成像(CMR)评估早期和中期修复结果。方法:对10例连续行心脏内修复术和单瓣重建术的患者进行研究。术后进行二维超声心动图和CMR比较诊断方式。结果:10例患者中,在随访1 ~ 6个月的CMR随访中,9例患者2D超声心动图诊断为轻度和中低度PR, CMR反流分数为10.8% ~ 28%,1例患者诊断为高中度PR,反流分数为39.6%。结论:我们的肺动脉瓣重建方法是合理的,在预防术后PR方面具有良好的短期和中期效果。CMR是一种优秀的无创的、独立于手术者的PR量化方法,它提供了一个可重复的、全面的修复评估,可常规用于TOF TAP修复患者的术后评估。图形化的简介:示意图A.虚线表示从右心室流出道延伸至肺动脉主动脉的切口,B.显示原生肺动脉瓣解剖图C.单眼位置用黄色表示。右室流出道-肺动脉连接处的横切面与单心包的位置与增厚显示固定心包条的位置。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Monocusp pulmonary valve reconstruction in Tetralogy of Fallot: early results and evaluation using 2D echocardiography and 3-T cardiac MRI.

Background: Transannular patch (TAP) repair of right ventricular outflow tract (RVOT) in intracardiac repair of Tetralogy of Fallot (TOF) has been plagued by residual anatomic and hemodynamic abnormalities leading to mortality and morbidity. While efforts have been made to mitigate the effects of free pulmonary regurgitation (PR) following TAP repair, no single method demonstrated superior results. In this paper, we tried a novel method of monocusp pulmonary valve reconstruction using a strip of fixed autologous pericardium at the monocusp edge and assessed the early and mid-term results of the repair using two-dimensional (2D) echocardiography and cardiac magnetic resonance imaging (CMR).

Methods: Ten consecutive patients who underwent intracardiac repair with TAP and monocusp reconstruction of pulmonary valve were studied. Postoperative 2D echocardiography and CMR were done to compare the diagnostic modalities.

Results: Of the ten patients, nine were diagnosed to have only mild and low moderate PR on 2D echocardiography and regurgitant fraction of 10.8 to 28% on CMR during a follow-up period of 1 to 6 months using CMR, and one was diagnosed to have high moderate PR with regurgitant fraction 39.6%. Both the modalities had comparable results in diagnosing postoperative PR.

Conclusion: Our method of pulmonary valve reconstruction is reasonable and provides good short-term and mid-term results in preventing postoperative PR. CMR is an excellent non-invasive operator-independent modality for the quantification of PR which provides a reproducible and comprehensive assessment of the repair and can be routinely used for the postoperative assessment of patients undergoing TAP repair of TOF.

Graphical abstract: Schematic diagram A. The dotted line represents the incision extending from the right ventricular outflow tract to the main pulmonary artery, B. Visualising the native pulmonary valve anatomy C. the position of the monocusp represented in yellow, and the brown line demonstrating the strip of fixed pericardium D. Cross section of the right ventricular outflow tract- pulmonary artery junction with the position of monocusp with the thickening demonstrating the position of the strip of fixed pericardium.

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来源期刊
Indian Journal of Thoracic and Cardiovascular Surgery
Indian Journal of Thoracic and Cardiovascular Surgery CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
1.20
自引率
14.30%
发文量
141
期刊介绍: The primary aim of the Indian Journal of Thoracic and Cardiovascular Surgery is education. The journal aims to dissipate current clinical practices and developments in the area of cardiovascular and thoracic surgery. This includes information on cardiovascular epidemiology, aetiopathogenesis, clinical manifestation etc. The journal accepts manuscripts from cardiovascular anaesthesia, cardiothoracic and vascular nursing and technology development and new/innovative products.The journal is the official publication of the Indian Association of Cardiovascular and Thoracic Surgeons which has a membership of over 1000 at present.DescriptionThe journal is the official organ of the Indian Association of Cardiovascular-Thoracic Surgeons. It was started in 1982 by Dr. Solomon Victor and ws being published twice a year up to 1996. From 2000 the editorial office moved to Delhi. From 2001 the journal was extended to quarterly and subsequently four issues annually have been printed out at time and regularly without fail. The journal receives manuscripts from members and non-members and cardiovascular surgeons. The manuscripts are peer reviewed by at least two or sometimes three or four reviewers who are on the panel. The manuscript process is now completely online. Funding the journal comes partially from the organization and from revenue generated by subscription and advertisement.
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