Application Of Palliative Right Ventricular - Pulmonary Artery Embolization In Pulmonary Atresia With Ventricular Septal Defect And Choice Of Pipeline

Part Ⅰ. The Application of Palliative Right Ventricular-pulmonary artery shunt in Pulmonary Atresia with Ventricular Septal Defect.Objective To assessed the value of the Palliative Right Ventricular-pulmonary artery shunt in Staged Surgical Management of Pulmonary Atresia with Ventricular Septal Defect.Methods we retrospectively analyzed the clinical data of65patients underwent reconstruction of right ventricular-pulmonary artery (RV-PA) in Fu Wai Hospital from July2009to March2014, aged from44days to29years,(The median age was13m) with the body weight ranged from3.4to49.5kg(10.84±7.75kg); The percutaneous oxygen saturation (SpO2) of preoperative ranged from0.60to0.95(0.75±0.077)..Results64patients received parallel cardiopulmonary bypass,1patient underwent surgery with heart arrest。The mean time of CPB was37-184min (88.3±30.8), Postoperative ventilator time was8-1584h (the mean74.2±201h); ICU stay17-1622h (120.3±207.9h).There was no perioperative mortality in65patients. The percutaneous saturation (SpO2) of all patients increased by13±6.56%, ECG showed all of the patients were sinus rhythm.64patients were classified as New York Heart Association (NYHA) Ⅱ. Conclusion Right Ventricular-pulmonary artery shunt can maintain pulmonary blood flow, stabilize hemodymincs, be ready for Two-stage radical surgery. Part Ⅱ. The choice and application of the shunt size and material in reconstruction of right ventricular-pulmonary arteryObjective1To assess the effects of three materials (Gore-tex, bovine jugular vein and autologous pericardium) in reconstruction of right ventricular-pulmonary artery (RV-PA) continuity.2To explore correlation between suitable size of conduit and weight or McGoon ratio.Methods we retrospectively analyzed the clinical data of24patients underwent reconstruction of right ventricular-pulmonary artery (RV-PA) in Fu Wai Hospital from July2010to July2012,including22pulmonary atresia with ventricular septal defect (PAVSD) patients,1double outlet right ventricle (DORV) patient,1Tetralogy of Fallot (TOF) patient.There were11males and13females,aged from60.0days to6.0years,with the body weight ranged from4.8to21.5kg(mediani13.15kg).The17patients in autologous pericardium group, aged from60days to6years, with the body weight ranged from4.8-18.5kg (9.53±3.78kg), the average McGoon ratio was1.017±0.28; The5patients Gore-tex group aged from7m-70m, with the body weight ranged from7～12.5kg (9.08±2.24kg), the average McGoon ratio was1.082±.37.The age of2patients in bovine jugular vein group was2y and4y, the body weight was16kg和21.5kg, the McGoon ratio was0.603和0.71. Results There was no perioperative mortality in24patients..The percutaneous saturation (SpO2) of autologous pericardium group increased by20.25±28.33%,the Gore-tex group incread by22.23±21.43, the bovine jugular vein group increased by15%and17%. ECG showed all of the patients were sinus rhythm.23patients were classified as New York Heart Association (NYHA) II, and1as III.The postoperative ventilator time and hospital time of autologous pericardium patients were shorter than Gore-tex patients (p=0.017and0.02); bovine jugular vein patients were20h、56h and14d、20d. The followed-up time was10m～2y (average1.4y).16patients were followed up by angiocardiography or computed tomography(12patients in autologous pericardium group,.3patients in Gore-tex group and1patient in bovine jugular vein group.).The follow-up McGoon ratio in autologous pericardium group was1.983±0.27, in Gore-tex group was1.903±0.33, the MaGoon ratio of the only patient followed up in bovine jugular vein group was1.682.All the followed-up patients’ MaGoon ratio increaseed obviously (the autologous pericardium group p=0.016, the Gore-tex group p=0.006). Two-stage radical surgery was successfully performed for6patients (5patients among the autologous pericardium group,1patient among the Gore-tex group). There was no severe complication interrelated with the surgery.By use of the line regression, we could conclude a formula for suitable size of conduit and weight:conduit diameter (mm)=0.327×weight (kg)+4.599. But computing result of the formula was not integer, so we corrected the result by use of MaGoon ratio. Contrast analyzs the size of conduit with MaGoon ratio, the calculation of the formula, we found that when MaGoon<0.8, we could choose the first integer which was greater than the calculation of the formula; When MaGoon ratio>1.2, we could choose the first integer which was less than the calculation of the formula; When1.2>MaGoon>0.8, we could choose the integer less or greater than the calculation of the formula.Compare the recovery time, the size of the conduit the patients who recovered more quickly was more suitable to the correction.Conclusion1Three materials could be chosen as the conventional material.2We could choose a conduit of suitable size on the basis of patient’s weight and McGoon ratio in reconstruction of right ventricular-pulmonary artery (RV-PA) conduit.