论文部分内容阅读
随着法洛四联症(tetralogy of Fallot,TOF)手术方法越来越成熟,TOF患儿存活率得到较大提升,然而TOF术后的远期并发症成为影响预后的重要因素,其中最常见的为肺动脉瓣反流(pulmonary regurgitation,PR),可以导致右心室功能不全、运动耐力下降以及心律失常,甚至猝死.肺动脉瓣置换术(pulmonary valve replacement,PVR)是治疗PR的有效手段,手术方式包括传统外科肺动脉瓣置换术(surgical pulmonary valve replacement,SPVR)、经皮肺动脉瓣置换术(percutaneous pulmonary valve replacement,PPVR)及镶嵌治疗.对于肺动脉瓣的替代物,生物瓣膜仍然为大多数医生的首要选择,随着抗凝方案的完善,机械瓣膜也有其特定的适应人群,PVR术后的抗凝方案也不尽一致.现对TOF根治术后PVR的手术指征、肺动脉瓣替代物的选择与术后抗凝方案以及临床治疗进展进行综述.“,”With constant refining of surgical methods for tetralogy of Fallot (TOF),the survival rate of TOF children has greatly improved.However,the long-term postoperative complications of TOF have become important prognostic factors.The most common complication of pulmonary regurgitation (PR) may lead to right ventricular dysfunction,exercise intolerance,arrhythmia and even sudden death.As an effective treatment for PR,pulmonary valve replacement (PVR) includes surgical pulmonary valve replacement (SPVR),percutaneous pulmonary valve replacement (PPVR) and hybrid therapy.Bioprosthetic valve has remained a primary choice of substituting pulmonary valve.With the improvements of anticoagulation regimens,mechanical valve has its own applicable population and anticoagulation regimens after PVR are also inconsistent.This article reviews the indications of pulmonary valve replacement after radical TOF operations,selecting pulmonary valve replacements,anticoagulant regimens after radical TOF operations and clinical therapeutic advances.