Left atrioventricular valve regurgitation after correction of atrioventricular septal defects.
Left atrioventricular valve regurgitation after correction of atrioventricular septal defects.
复制标题
房室间隔缺损矫正后左房室瓣关闭不全。
DOI：
10.15017/21645
复制
发表时间：
2012
期刊：
影响因子：
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通讯作者：
R. Tominaga
中科院分区：
文献类型：
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作者：
Y. Shiokawa;T. Nishida;A. Nakashima;R. Tominaga
目的
左房室瓣（AV）进行性反流仍然是房室间隔缺损（AVSD）修复术后的一个主要问题。本研究的目的是回顾该机构针对严重左 AV 瓣膜反流的 AVSD 修复和再手术病例系列。
方法
1990年2月至2011年3月期间，49例患者接受了AVSD初次修复，其中4例因左房室瓣关闭不全而接受了再次手术。另有5名患者在1990年之前接受过AVSD初次修复，同期又接受了左AV瓣手术。本研究回顾性回顾了所有 AVSD 手术病例，并考虑了左 AV 瓣膜关闭不全的原因，并进一步探讨了如何最有效地处理这一问题。
结果
初次修复 AVSD 后，有 4 例早期死亡（8.6%），无晚期死亡。左房室瓣再次手术后未观察到死亡。六名患者接受了左房室瓣的重新修复，但三名患者需要更换人工瓣膜。对6例重新修复的病例进行了额外的裂隙闭合和连合成形术。 6例重新修复病例中未观察到明显的房室瓣关闭不全。 AVSD 修复后 10 年和 15 年的精算生存率为 92%。研究期间初次修复后幸存的患者在 10 年和 15 年免于再次手术的比例为 81%。在研究期间初次修复后幸存的所有患者在 10 年时没有发生严重左 AV 瓣反流的率为 46%。最后 2 例采用 Gore-Tex 移植物进行部分环成形术，取得了令人鼓舞的结果。
结论
就死亡率和无需再次手术的比率而言，结果是可以接受的，但没有出现明显的左房室瓣反流的情况令人失望。严重左房室瓣反流的再次手术结果也令人满意。应用 Gore-Tex 移植物对左 AV 瓣进行部分瓣环成形术似乎是一种潜在有用且有效的治疗方式。
PURPOSE
Progressive regurgitation of the left atrioventricular valve (AV) remains a major postoperative problem in the repair of atrioventricular septal defect (AVSD). The aim of this study was to review a case series of AVSD repair and reoperation for significant left AV valve regurgitation from this institution.
METHODS
Forty-nine patients underwent initial repair of AVSD between February 1990 and March 2011, and 4 of them underwent reoperation for left AV valve regurgitation. Another 5 patients, who had received initial repair of AVSD before 1990, underwent reoperation of the left AV valve during the same period. This study retrospectively reviewed all cases of AVSD operation, and considered the causes of the left AV valve incompetence, and furthermore addressed how to manage most effectively this problem.
RESULTS
There were 4 early deaths (8.6%) and no late deaths after initial repair of AVSD. No death was observed after reoperation of the left AV valve. Six patients underwent re-repair of left AV valve, but three patients needed prosthetic valve replacement. An additional cleft closure and commissuroplasty were performed on the 6 re-repaired cases. No significant AV valve regurgitation was observed among the 6 re-repaired cases. The actuarial survival was 92% at 10 and 15 years after AVSD repair. Freedom from reoperation of the left AV valve was 81% at 10 and 15 years for the patients who survived the initial repair during the study period. Freedom from significant left AV valve regurgitation was 46% at 10 years for all patients who survived the initial repair during the study period. A partial ring annuloplasty using Gore-Tex graft was applied to the last 2 cases, and this employment yielded encouraging results.
CONCLUSION
The results were acceptable in terms of the mortality and reoperation free ratio, but the freedom from significant left AV valve regurgitation was disappointing. The outcome of reoperation for significant left AV valve regurgitation was also satisfactory. The application of Gore-Tex graft partial annuloplasty of the left AV valve appears to be a potentially useful and effective treatment modality.
木材工业。39-7。
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