Abstract
Introduction. In the first part of our study, it was shown that immediately after implantation pulmonary allograft is an effective method for reconstructing the outflow tract of the venous ventricle. The presence of a perfect obturator element, as well as the absence of a significant pressure gradient between the ventricle and pulmonary arteries, create the most physiological conditions for hemodynamics of the pulmonary circulation. The aim of this study is to assess the possibilities of pulmonary allograft in children in the mid-term after implantation.
Material and methods. The volume of the study was 27 patients who underwent pulmonary allograft implantation and were discharged from the department. Average age 9.2 ± 3.1 (from 5.5 to 17) years; the average body weight is 28.3 ± 12.6 (from 11 to 56) kg. The duration of follow-up was on average 4.5 ± 2.9 (from 1 year to 13) years. A dynamic assessment of the clinical condition of the patients was carried out. The assessment of the physical properties and functional state of the allograft was based on the data of transthoracic echocardiography.
Results. There were no deaths. Over 50% of the patients corresponded to the first functional class. In almost all cases, the valve flap mobility and the blocking ability of the valve were preserved. In 93% of cases, there were no degenerative changes in the walls of the allograft. At the same time, a tendency towards an increase in the pressure gradient was revealed. Nine patients were operated on again. In one case, about a false aneurysm of the excretory tract, 8 patients – due to an increase in the pressure gradient. In 2 cases, it was endovascular surgery, 6 patients were operated on under cardiopulmonary bypass in an average of 7.3 ± 8.0 years. All patients underwent successful intervention.
Conclusion. Reconstruction of the venous ventricular outflow tract fully complies with the principle of physiological correction of congenital heart disease. On the one hand, this guarantees a good quality of life for the patient after surgery on the other hand protection of the venous ventricle is achieved at the stage of primary defect correction. Keywords: congenital heart defects, pulmonary allograft, chronic pulmonary failure.
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About the authors
- Mikhail A. Zelenikin, Dr. Med. Sci., Professor, Chief Researcher; ORCID
- Sergey S. Volkov, Cand Med. Sci., Senior Researcher; ORCID
- Ivan T. Narmaniya, Researcher;ORCID
- Dmitriy V. Britikov, Dr. Med. Sci., Head of Laboratory; ORCID
- Mikhail M. Zelenikin, Dr. Med. Sci., Professor, Head of Department; ORCID
