Valved apico-aortic composite conduits for left ventricular outflow tract obstructions. A 4 year experience with 27 patients.
Valved apico-aortic composite conduits for left ventricular outflow tract obstructions. A 4 year experience with 27 patients.
复制标题
用于左心室流出道梗阻的带瓣心尖主动脉复合导管。
DOI：
10.1016/0002-9149(80)90488-9
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发表时间：
1980
期刊：
影响因子：
--
通讯作者：
D. Cooley
中科院分区：
文献类型：
--
作者：
J. C. Norman;M. Nihill;D. Cooley
在27例（男16例，女11例）患者中建立了一个双出口左心室，并在左心室尖部和腹腔上腹主动脉之间插入了一个特殊的复合假体。年龄4 ~ 72岁，平均23岁。术前血流动力学研究显示平均（±标准差）峰值左心室收缩压为213 ± 36 mm Hg，平均左心室流出道压差为93 ± 33 mm Hg。术后，平均左心室收缩压降至128 ± 26 mm Hg（p <0.01），从左心室到升主动脉的平均压差降至14 ± 17 mm Hg（p < 0.01）。用velocity-tipped导管探头测定的左心室心输出量分数显示，通过主动脉瓣的平均顺行血流为69 ± 10%，通过复合管道的逆行血流为31 ± 9%。最长的随访期接近48个月。早期死亡率为11%，晚期死亡率相似。在存在多次既往手术和小主动脉流出道瓣膜置换术引起的小瓣膜环或溶血或两者的情况下，该方法简单、快速且有效。在复杂的情况下，这种手术可能比设计用于扩大流出道的手术简单。
A double outlet left ventricle with a special composite prosthesis interposed between the left ventricular apex and the supraceliac abdominal aorta was created in 27 patients (16 male and 11 female). Their ages ranged from 4 to 72 years (mean 23). Preoperative hemodynamic studies demonstrated a mean (± Standard deviation) peak left ventricular systolic pressure of 213 ± 36 mm Hg with a mean left ventricular outflow gradient of 93 +- 33 mm Hg. Postoperatively, mean left ventricular systolic pressure decreased to 128 +- 26 mm Hg (p <0.01) and the mean gradient from the left ventricle to the ascending aorta decreased to 14 ± 17 mm Hg (p < 0.01). Fractionation of the left ventricular cardiac output determined with velocity-tipped catheter probes revealed an average anterograde flow through the aortic valve of 69 ± 10 percent and a retrograde flow through the composite conduit of 31 ± 9 percent. The longest follow-up period is approaching 48 months. The early mortality rate was 11 percent with a similar late mortality rate. In the presence df multiple previous procedures, and diminutive anuli or hemolysis from valve replacement in small aortic outflow tracts or both, this approach is straightforward, expeditious and effective. In complicated situations, this procedure may be simpler than those designed to enlarge the outflow tract.