目的 總結(jié)右心室流出道梗阻經(jīng)右心房切口、三尖瓣口行右心室流出道疏通術(shù)的經(jīng)驗(yàn)?！》椒ā∽?007年6月至2010年12月，安徽醫(yī)科大學(xué)第一附屬醫(yī)院對21例右室雙腔心、單純右心室流出道狹窄及法洛四聯(lián)癥患者［（14例右室雙腔心、4例單純右心室流出道狹窄和3例法洛四聯(lián)癥，流出道壓差為（52.56±17.31） mm Hg］，經(jīng)右心房切口、三尖瓣口行右心室流出道疏通術(shù)，切除異常纖維環(huán)和增生肥厚肌束，疏通右心室流出道，對并發(fā)肺動脈瓣或瓣下狹窄的患者，再經(jīng)肺動脈根部切口協(xié)助顯露，同時矯正其他并發(fā)畸形?！〗Y(jié)果 所有患者手術(shù)順利，術(shù)后心功能均恢復(fù)滿意，術(shù)后超聲心動圖復(fù)查提示：右心室流出道疏通效果滿意，壓差＜20 mm Hg，7例術(shù)后有輕度收縮期雜音。術(shù)后隨訪至6個月，隨訪期間所有患者體力活動完全恢復(fù)；復(fù)查心臟彩色超聲心動圖提示:無明顯右心室流出道室壁肥厚增生和再梗阻，右心室流出道壓差進(jìn)一步縮小或消失?！〗Y(jié)論 經(jīng)右心房切口行右心室流出道疏通術(shù)適用于右室雙腔心、單純右心室流出道狹窄及部分法洛四聯(lián)癥患者，可避免直接切開右室壁引起的心肌、冠狀動脈損傷，減輕了術(shù)后瘢痕纖維增生，有利于術(shù)后心功能恢復(fù)。
引用本文： 何維來,周汝元,葛圣林,張士兵,張成鑫,馮俊波,車轟. 經(jīng)右心房切口行右心室流出道疏通術(shù). 中國胸心血管外科臨床雜志, 2012, 19(4): 430-432. doi: 復(fù)制
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| 13. | van de Woestijne PC, Mokhles MM, de Jong PL, et al. Right ventricular outflow tract reconstruction with an allograft conduit in patients after tetralogy of Fallot correction：long-term follow-up. Ann Thorac Surg, 2011, 92 （1）：161-166. |
| 14. | Kimberly AH, Dearani JA, Burkhart HM, et al. Risk factors and early outcomes of multiple reoperations in adults with congenital heart disease. Ann Thorac Surg, 2011, 92 （1）：122-130. |
| 15. | Sullivan R, Huang GY, Meyer RA, et al. Heart malformations in transgenic mice exhibiting dominant negative inhibition of gap junctional communication in neural crest cells. Dev Biol, 1998, 204 （1）：224-234. |
| 16. | Butz T, Horstkotte D, Langer C, et al. Significant obstruction of the right and left ventricular outflow tract in a patient with biventricular hypertrophic cardiomyopathy. Eur J Echocardiogr, 2008, 9 （2）：344-345. |
- 1. Nakamura T, Gulick J, Colbert MC, et al. Protein tyrosine phosphatase activity in the neural crest is essential for normal heart and skull development. Proc Natl Acad Sci USA, 2009, 106 （27）：11270-11275.
- 2. Kreymborg KG, Uchida S, Gellert P, et al. Identification of right heart-enriched genes in a murine model of chronic outflow tract obstruction. J Mol Cell Cardiol, 2010, 49 （4）：598-605.
- 3. Wald RM, Haber I, Wald R, et al. Effects of regional dysfunction and late gadolinium enhancement on global right ventricular function and exercise capacity in patients with repaired tetralogy of Fallot. Circulation, 2009, 119 （10）：1370-1377.
- 4. Bashore TM. Adult congenital heart disease：right ventricular outflow tract lesions. Circulation, 2007, 115 （14）：1933-1947.
- 5. Basu S, Kumar D, Mukherjee D, et al. Double chambered right ventricle and congenital complete heart block：a unique association. Congenit Heart Dis, 2007, 2 （4）：270-274.
- 6. Sarikouch S, Schaeffler R, Blanz U, et al. Adult congenital heart disease-double-chambered right ventricle. Clin Res Cardiol, 2007, 96 （8）：582-584.
- 7. Starr JP. Tetralogy of fallot：yesterday and today. World J Surg, 2010, 34 （4）：658-668.
- 8. Kottayil BP, Dharan BS, Pillai VV, et al. Surgical repair of doubl e-chambered right ventricle in adulthood. Asian Cardiovasc Thorac Ann, 2011, 19 （1）：57-60.
- 9. Tao L, Zeng X. Right ventricular outflow tract patch reconstruction in anomalous origin of right coronary artery. Ann Thorac Surg, 2010, 89 （4）：1314-1316.
- 10. Mert M, Cetin G. Right ventricular outflow tract reconstruction for tetralogy of fallot with abnormal coronary artery：experience with 35 patients. J Card Surg, 2006, 21 （2）：131-136.
- 11. Yuan SM, Mishaly D, Shinfeld A, et al. Right ventricular outflow tract reconstruction：valved conduit of choice and clinical outcomes. J Cardiovasc Med, 2008, 9 （4）：327-337.
- 12. Spiewak M, Biernacka EK, Ma?ek ?A, et al. Right ventricular outflow tract obstruction as a confounding factor in the assessment of the impact of pulmonary regurgitation on the right ventricular size and function in patients after repair of tetralogy of Fallot. J Magn Reson Imaging, 2011, 33 （5）：1040-1046.
- 13. van de Woestijne PC, Mokhles MM, de Jong PL, et al. Right ventricular outflow tract reconstruction with an allograft conduit in patients after tetralogy of Fallot correction：long-term follow-up. Ann Thorac Surg, 2011, 92 （1）：161-166.
- 14. Kimberly AH, Dearani JA, Burkhart HM, et al. Risk factors and early outcomes of multiple reoperations in adults with congenital heart disease. Ann Thorac Surg, 2011, 92 （1）：122-130.
- 15. Sullivan R, Huang GY, Meyer RA, et al. Heart malformations in transgenic mice exhibiting dominant negative inhibition of gap junctional communication in neural crest cells. Dev Biol, 1998, 204 （1）：224-234.
- 16. Butz T, Horstkotte D, Langer C, et al. Significant obstruction of the right and left ventricular outflow tract in a patient with biventricular hypertrophic cardiomyopathy. Eur J Echocardiogr, 2008, 9 （2）：344-345.