Clinical Research On Autologous Monocnspid Valve Patch In The Correction Surgery Of Tetralogy Of Fallot

Objective In In tetralogy of Fallot correction surgery, using through active distilled water treated autologous pericardial patch to reconstruct the right ventricular outflow tract were two methods alone autologous pericardial patch and valved autologous pericardial patch, and in the long-term effects of postoperative clinical evaluation.Methods From June 2000 to June 2012, a total of 125 cases in our hospital tetralogy of Fallot patients were underwent surgical correction of a period. Incision surgery with Dacron graft repair of ventricular septal defect through the right atrium, then longitudinal incision right ventricular outflow tract, pulmonary valve annulus reach distal pulmonary artery stenosis, cut off the outflow tract hypertrophy interval, muscle bundles, wall beams and narrow rings and other organizations,to clear the narrow outflow tract using autologous pericardial patch produced pulmonary artery patch to expand cross-ring reconstruction of the right ventricular outflow tract. For cross-ring patch production, A group with simple pericardium, group B is used already sewn good valved autologous pericardial patch. Intraoperative calculated based on the patient’s body surface area corresponding to the pulmonary valve annulus diameter, minus the patient’s own pulmonary valve annulus diameter, to determine the appropriate width of the pericardial patch. Surgery to cut out the appropriate size of the pericardial patch to remove surface fat, connective tissue and other tissues, the use of sterile distilled waterafter 30 min. A group will be trimmed into fusiform pericardial patch, group B in the pericardial patch equivalent to the level of the pulmonary valve annulus impose a semi-continuous suture 5-0Prolene pericardium, forming a half flap pocket, made into a valved pericardial patch. Two groups of patients after surgical methods were followed by ongoing long-term follow-up echocardiography, insufficiency extent and activity changes compare postoperative pulmonary valve in order to evaluate the clinical effects of two surgical techniques.Results For row tetralogy of Fallot a period of 125 patients corrective surgery, postoperative pericardial patch group simply mean follow-up time of 63 ± 8 months, patients valved autologous pericardial patch group mean follow-up time of 55 ± 7 months. Statistical analysis comparing the two groups of patients age, body surface area, heart rate, the diameter of the main pulmonary artery, left / right pulmonary artery diameter, cardiopulmonary bypass time, postoperative chest tube was no significant difference in volume. To assess the pulmonary insufficiency of the main two groups of patients after surgery extent and degree of pulmonary valve stiffness that changes in the activity of the valve.Echocardiographic assessment of pulmonary valve insufficiency is now mostly semi-quantitative criteria, namely mild- diastolic flow reversal limited pulmonary valve annulus level; moderate- you can see the main pulmonary artery diastolic flow reversal but not exceeding the level of the pulmonary artery branches; severe- can also be seen in the pulmonary artery branch diastolic flow reversal. To define the extent of the valve according to the degree of stiffness LV end-diastolic pulmonary valve can close the pulmonary artery, namely, mild- left ventricular end-diastolic pulmonary valve easily, can be close to the pulmonary artery wall; moderate- poor activity of pulmonary valve opening by limit; severe- poor activity pulmonary valve opening was limited. In the postoperative follow-up period, with extended follow-up period, the two groups of patients with pulmonary valve insufficiency, valvular degree of stiffness has aggravated the trend, and valved patchpatients autologous pulmonary valve in the same follow-up period after surgery insufficiency and reduce the degree of activity was significantly lower than patients pericardial patch.Conclusions In tetralogy of Fallot correction surgery, the use of distilled water through the valved treated autologous pericardial patch to reconstruct the right ventricular outflow tract, helping to reduce postoperative pulmonary valve insufficiency and mitigation stiff valve thickening degree, conducive to the recovery of cardiac function in patients, and achieved good results in the long-term clinical.