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題 名 | Echocardiography of the Right Ventricle-to-Pulmonary Artery Homograft Conduit of Patients with Transposition of the Great Arteries or Double Outlet Right Ventricle Undergoing the Rastelli Procedure=施與Rastelli Procedure之大動脈轉位症或右心室雙出口症病患之右心室-肺動脈之Homograft管道之超音波血流再視化的研究 |
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作 者 | 袁師敏; 張綠莎; 徐瓊枝; 郭加強; | 書刊名 | 中華醫學雜誌 |
卷 期 | 59:6 1997.06[民86.06] |
頁 次 | 頁359-366 |
分類號 | 416.262 |
關鍵詞 | 複雜先天性心臟病; 杜卜勒血流再視化; 心臟超音波; 開心手術; 肺循環; Complex congenital heart defects; Doppler flow pattern; Echocardiography; Open heart surgery; Pulmonary circulation; |
語 文 | 英文(English) |
中文摘要 | 背景:含瓣膜之aortic homograft對於複雜先天性心臟病重建右心室出口具有相當重要的價值。 方法:自1995年,12例合併肺動脈狹窄及心室中隔缺損之大動脈轉位症或右心室雙出口症之病患,年齡3-22歲,施與Rastelli procedure,採用超低溫冷凍保存的含瓣膜之aortic homograft重建右心室出口。 結果:因病變複雜致手術死亡3例(25%)。1例(8.33%)施與Rastelli procedure術後30天死於肺栓塞。8例(66.67%)存活無症狀,其術後平均住院期22天。術前杜卜勒超音波血流再視化不僅顯示心房、心室及大動脈的對應關係,而且可顯示心內解剖。右心房及右心室內可探及五彩血流(n=11)。術後超音波血流再視化顯示含瓣膜之homograft管道位於右心室與肺動脈之間,含瓣膜之homograft中的瓣膜隱約可見。含瓣膜之homograft內可見隨心臟舒縮節律出現的五彩血流(n=8)。Rastelli procedure手術前、後經肺動脈瓣血流峰值流速及跨瓣壓差相比較,具有極為顯著的差異,Rastelli procedure術後顯著降低(4.13 +/- 0.44 m/s,3.15 +/- 1.13 m/s,p = 0.032;72.46 +/- 15.79 mmHg,39.87 +/- 23.23mmHg,p = 0.003)。其餘各瓣膜血流峰值流速及跨瓣壓差術前及術後相比較均無顯著性差異。 結論:不考慮手術死亡率,含瓣膜之aortic homograft管道是矯正複雜先天性心臟病理想的選擇。 |
英文摘要 | Background: Aortic valved homograft conduits have been valuable in right ventricular outflow tract (RVOT) reconstruction in complex congenital heart disease. Methods: Since 1995, 12 patients ranging in age from 3 to 22 years, with transposition of the great arteries or double outlet right ventricle associated with pulmonary stenosis and ventricular septal defect, underwent the Rastelli procedure with the RVOT reconstruction utilizing cryopreserved aortic valved homograft conduits. Results: Operative deaths for three patients were caused by the complexity of the heart defects (25%). One late death (8.33%) occurred as a result of pulmonary embolism one month after conduit implantation. The remaining eight patients (66.67%) survived asymptomatically with a mean postoperative hospitalization of 22 days. Preoperative Doppler echocardiographic flow visualization distinguished not only the corresponding location among the atrium, ventricle and great arteries, but also intracardiac. Mosaic flow pattern could be detected in the right ventricle and right atrium (n = 11). Postoperative echocardiographic flow visualization showed the valved homograft extracardiac conduit lay between the right ventricle and the pulmonary artery, and the valve inside the conduit could faintly be seen. Mosaic flow pattern could be observed with the systole and diastole jet in the cardiac circle (n = 8). Peak velocity and pressure gradient across the pulmonary valve after the Rastelli procedure were significantly decreased when compared with those before operation (4.13 +/- 0.44 m/s vs. 3.15 +/- 1.13 m/s, p = 0.032; 72.46 +/- 15.79 mmHg vs. 39.87 +/- 23.23 mmHg, p = 0.003). However, there were no significant differences between pre- and postoperative peak velocity and pressure gradient beyond the pulmonary valve. Conclusions: Apart from operative mortality, the application of aortic valved homograft conduits were all excellent choice for the correction of complex congenital heart disease. |
本系統中英文摘要資訊取自各篇刊載內容。