| BackgroundTetralogy of Fallot is the most common type of cyanotic congenital heart disease.Its radical operation has been 60 years since its inception.With the continuous improvement of surgical methods and perioperative management,the surgical effect has been significantly improved The main purpose is to close the poorly positioned ventricular septal defect,relieve the right ventricular outflow obstruction and widen the narrowed pulmonary artery.The most critical part of the operation is the treatment of the right ventricular outflow tract,not only to relieve the stenosis of the right ventricular outflow tract,but also to avoid postoperative pulmonary valve regurgitation.The traditional treatment method is transvalvular patch widening,but this method causes the absence and ineffectiveness of the pulmonary valve.Postop-erative pulmonary valve regurgitation leads to an increase in right ventricular volume load and pressure load.And structural changes,eventually making the right heart fail.With the deepening of the understanding of tetralogy of Fallot,the strategy for reconstruction of the right ventricular outflow tract has changed accordingly.It is currently advocated to preserve the function of the pulmonary valve in the reconstruction of the right ventricular outflow tract as much as possible to reduce postoperative pulmonary valve regurgitation The resulting complications.To this end,we used a single valve patch of Gore-Tex membrane to reconstruct the right ventricular outflow tract in the radical operation of tetralogy of Fallot to protect the function of the pulmonary valve.ObjectiveThe purpose of this study was to understand the efficacy of the use of a polytetrafluoroethylene(Gore-Tex)membrane in the reconstruction of right ventricu-lar outflow tract for the treatment of tetralogy of Fallot.To explore the safety and feasibility of Gore-Tex membrane flap in the reconstruction of right ventricular outflow tract of tetralogy of Tetralogy of Fallot.MethodsThis study selected 234 children with tetralogy of Fallot(TOF)admitted to the Children's Heart Center of Zhengzhou University People's Hospital from June 2017 to September 2019.This study selected 234 children with TOF admitted to the Children's Heart Center of Zhengzhou University People's Hospital from June 2017 to September 2019.67 cases with poor pulmonary valve annulus development and pulmonary valve Z value<-3 were included.In all 67 children,Gore-Tex membrane flap repair was used to reconstruct right ventricular outflow tract(RVOT).Observe and record the cardiac ultrasound indicators,immediate success rate,and postoperative complications before and after surgery.Compare and analyze the cardiac ultrasound indicators before and after surgery.Follow-up echocardiography was performed in the clinic in January,March,June,1 year,and 2 years after operation to observe the opening and closing of the pulmonary valve,reflux,calcification,stenosis of the RVOT,and whether other complications occurred.ResultsAll the children in the entire group successfully completed the operation without death.The average cardiopulmonary bypass(CPB)time was 135±71min,the average aortic crossclamp time(ACCT)was 93 ± 54min,the average ventilator assist time was 78 ± 46h,and the average ICU stay time was 131 ±55h.Early postoperative compl-ications:3 cases of transient low cardiac output syndrome,5 cases of pericardial effu-sion,2 cases of arrhythmia,healed after corresponding comprehensive treatment;1 case of small residual defect of ventricular septum(flow rate<3.0m/s),with a diamet-er of 2mm,closes on its own after a 6-month review.Postoperative esophageal ultrasound examination after cardiopulmonary bypass:Gore-Tex single valve opened an closed well in all children,with 3 cases(4.5%)of mild pulmonary valve regurg-itation,no moderate to severe pulmonary valve regurgitation,and tricuspid valve regurgitation Occurred;postoperatively measured transpulmonary valve pressure difference and transpulmonary valve flow rate were significantly lower than before surgery,and the diameter of the pulmonary valve annulus was significantly increased compared with before surgery,P<0.05 was statistically significant;right ventricular ejection fraction(RVEF)and left ventricular ejection fraction(LVEF)had no significant changes compared with preoperative,P>0.05 had no statistical signific-ance;percutaneous oxygen saturation was significantly improved compared with preoperative,P<0.05 had statistical significance.The whole group was followed up for 4 to 28 months.During the follow-up period,the cyanosis symptoms of the children disappeared,diet and activity ability improved significantly,and no adverse events occurred.On January,March,June,1 year,and 2 years after operation,the echocardiogram was regularly reviewed.The Gore-Tex single valve opened and closed activities were good,no calcification,adhesion,tearing,thrombosis,and immune rejection did not occur.Problems such as infective endocarditis and hemolysis.Pulmonary valve regurgitation from Table 2 shows that there was no moderate or severe pulmonary valve regurgitation in January,March,and June;1 case of moderate pulmonary valve regurgitation occurred in 1 year and 2 years,and the same 1 patient.Table 3 shows the right ventricular outflow tract stenosis.Among 5 follow-ups,only one case had RVOT moderate stenosis at 2 years after surgery.Conclusion1.Polytetrafluoroethylene pericardium(Gore-Tex)membrane has good biocompatibility,is not easy to form thrombus and calcification,and is an ideal material for RVOT reconstruction.2.Gore-Tex membrane single flap patch has the advantages of sufficient sources,convenient material acquisition,easy production,unlimited growth,etc.,and is more suitable for infants and young children.3.Gore-Tex membrane single flap patch technology to expand the pulmonary valve and annulus is a safe,feasible and effective surgical method.4.Gore-Tex membrane single flap patch is satisfactory in early follow-up,and long-term results need further follow-up confirmation. |
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