| Objective: Ventricular septal defect (VSD) is a common kind of congenital heart disease, covers approximately 8.5-30.3 percent. VSD often causes pulmonary artery hypertension. This phenomena depends on the size of the defect, the magnitude of the left-to-right shunt, and the pulmonary vascular response to the increased pulmonary flow and pressure. Children with large size and more shunting VSD are easier getting pulmonary hypertension. The correction of congenital heart defects characterized by pulmonary hypertension is frequently associated with postoperative failure of the right heart. Many surgeons advocate that this kind of VSD shoud be closed before 2 years old in order to prenvent the increasing of the pulmonary artery pressure and pulmonary vascular resistence. But the diagnosis and surgical treatment of children with large VSD are often delayed because of variety of reasons in our country. This circumstance puts these children at increased risk for significant morbidity and mortality when closure of the VSD is performed. With the development of the heart surgery, especially the application of the unidirectionalvalve patch, the morbidity and mortality associated with the closure of a large VSD and pulmonary hypertension has decreased. But there are much controversial opinions in the application of the unidirectional valve patch. This study was designed to evaluate the clinical effects of the unidirectional valve patch in treating the patients with ventricular septal defect and severe pulmonary hypertension.Methods: We selected 30 patients with VSD and severe pulmonary hypertension. They were randomized into two groups: the unidirectional valve patch repairing group and conventional repairing group. The diagnosis were made by Doppler echocardiography in all patients, got the ratios between the systolic pulmonary arterial pressure and the systemic arterial pressure (Pp / PS) >0.75. There were no significant differences with aspect to age, weight, pulmonary artery pressure, heart-chest ratio, et al, between the two groups.In the conventional repairing group, the procedure was performed in the conventional manner, using Dacron patch. In the other group, the VSD was repaired with unidirectional valve patch, which was constructed from Dacron and pericardial patches. A fenestration was made in the central region of the Dacron patch. The size of the fenestration was 4~6mm, governed by the weight of the patient. The pericardial valve patch was sewn to the superior aspect of the fenestration on the left ventricular side, leaving 1/3 edge unsewing.All patients have inhaled oxygen, injected PGEi during the perioperative period.Duration of operation procedure, aortic cross-clamp time, bypass time, ventilative time, et al, was recorded. Observating the symptom of the pulmonary hypertension crisis and right ventricular failure and treated. Follow-up 1-18 months. Echocardiography was used to assess the effect.Result: The duration of operation procedure, the bypass time, ventilative time in the conventional repairing group were longer than that in the unidirectional valvepatch group(p < 0.05). While the aortic cross-clamp time in the unidirectional valve patch group was longer than that of the conventional one, but there was no significant difference(p > 0.05). There was no early mortality in the unidirectional valve patch group, and there was no pulmonary hypertension crisis. In the conventional group, 1 patient died because of the pulmonary hypertension crisis just after the operation, and 1 patient died because of the right heart failure 7 months after the operation. During the following-up date, patient of the unidirectional valve patch group were better on the classic of the heart function than those of the conventional group.Conclusion: The unidirectional valve patch allows a low-risk for closure of large VSD and elevate pulmonary artery pressure, prevents pulmonary hypertention crisis, decreases the operative mortality.
|
PDF Full Text Request