| Objective: The reconstruction of right ventricular outflow tract (RVOT) is a problem often encountered in complex congenital heart disease (CHD) operation, and is crucial to recovery of right heart function from operation and to the result of the operation. Presently, RVOT is usually widen with autologous pericardium patch or vascular prosthesis patch in clinic, which often results in right heart failure after the operation. This research applied self-prepared conduit valved aortic homograft (CAVH) patch and self-pericardium patch respectively to the reconstruction of RVOT, then compared the two methods to approach how the former affect the right heart function, and evaluated it's effect in clinic. Material and Method: Select thirty cases of complex CHD with RVOT infundibulum stenosis and pulmonary valve ring stenosis or affiliated pulmonary trunk stenosis, which were confirmed by ultrasonic cardiography (UCG) or by right heart catheter visualization from ju1.2003 to nov. 2004 in the second affiliated clinical hospital of Zhengzhou University. These patients were randomly divided into two groups: experimental group and control group, each of them included fifteen cases. RVOT was enlarged overpulmonary ring with cryoperserved viable CAVH patch in the experimental group and with autologous pericardium patch in the control group respectively. Central venous pressure (CVP), right ventricular systolic pressure (RVSP), left ventricular systolic pressure (LVSP), pulmonary artery pressure (PAP) were measured before closing the thoracic incisions. Pulmonary regurgitate (PR) grade and right heart function parameter, including right ventricular ejection fraction (RVEF) and right ventricular fraction of shortening (RVFS) , were measured by UCG at one week and at 6 months after operation respectively. Results: 1. Before closing the thoracic incisions, RVSP/LVSP in experimental and control group were 0. 51±0.12 mmHg and 58. 00±8. 65 mmHg respectively (P<0.01); RVSP in the two groups were 48. 73 ± 11. 72 mmHg and 58. 00±8. 65 mmHg respectively (P<0.05); RV-PAPG in the two groups were 7.45 ± 5.66 mmHg and 23.91 ± 12.35 mmHg (P<0.01); CVP in the two groups were 8.91 ± 1.79 mmHg and 16.27 ± 3.21 mmHg. The hemodynamic result of experimental group was much better than that of the control group. There is significant difference between two groups (P<0.01).2. At one week after the operation, follow-up with Doppler ultrasonography showed: in experimental group 12 cases had non-PR, 3 cases had mild PR, no case had moderate and ponderosus PR; in control group two cases had non-PR, 8 cases had mild PR, 5 cases had moderate and ponderosus PR. There is significant difference between two groups (P<0.01). At six months after the operation, Follow-up with Doppler ultrasonography showed: in experimental group 11 cases had non-PR, 4 cases had mild PR, no case had moderate and ponderosus PR; in control group, one case had non-PR, 8 cases had mild PR, 6 cases had moderate and ponderosus PR. There is also significant difference between two groups (P<0.01).3. At one week after the operation, follow-up with Doppler ultrasonography showed: RVEF in experimental and control group were 0. 53±0. 01 and 0. 51±0.01 respectively (P<0.01); RYFS in the two groups were 0.26±0.01 and 0.24 ± 0.01 respectively (P<0.05) . At six months after the operation, Follow-up with Doppler ultrasonography showed: RVEF in experimental and control group were 0. 55±0. 01 and 0.53±0.01 respectively (P<0.01); RVFS in the two groups were 0. 30 ± 0. 01 and 0. 27±0.01 respectively (P<0.05). Conclusion: Compared with the RVOT reconstruction with autologous pericardium patch, the RVOT reconstruction with CYAH patch can effectively avoid pulmonary regurgitation and acquire a better hemodynamic result and a better protection to right heart function in early metaphase after operation. The CVAH is an ideal material for RVOT reconstruction. |
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