• 作者： 邱英世; 侯書文; 侯守賢; 王允文
• 作者服務機構： 台大醫院外科; 台大醫院病理科
• 中文摘要： 在小兒科的病人連接右心室至肺動脈幹採用何種瓣膜或帶有瓣膜的連通管一直是困擾心臟外科醫師的課題。我們在20隻平均體重12.2公斤乳豬經由雙側開胸術取出心包膜，其中10隻（PG組）用0.6％Glutaraldehyde浸5分鐘，再用生理食鹽水沖洗，另外10隻（PN組）只是浸在生理食鹽水。然後再將心包膜縫成三片式的瓣膜再縫成心包膜連通管並重建伏氏竇。最後將此帶有瓣膜的連通管的近端縫到右心室出口，遠端縫到肺動脈，然後將肺動脈幹結紮。PG組的豬活了114±92天，體重增加至42±29公斤；PN組活82±50天，體重增加至30±9公斤。在兩組的瓣膜皆沒有沾黏至連通管壁。在PN組的瓣膜呈現萎縮並有狹窄，在瓣膜近端的連通管有7隻呈現動脈瘤；在PG組只有1隻出現動脈瘤。在PG組的瓣膜和連通管有隨生存期生長的趨勢；在PN組則無。在PG組鈣化的現象比PN組明顯（瓣膜9/10比5/10，連通管8/10比6/10），但統計學上並無意義。組織學檢查顯示兩組的連通管皆有存活的纖維原細胞，而且彈性纖維可由肺動脈幹之管壁延伸長入連通管之管壁，只有1隻PG組的彈性纖維沒有長入連通管壁。PG組的瓣膜有9/10仍然存活；而PN組只有6/10。我們有兩個結論：第一，伏氏竇可以避免瓣膜與管壁沾黏。第二，帶有瓣膜的心包膜連通管用Glutaraldehyde浸潤以後比沒有浸潤的心包膜代用品在成長的豬的長期效果較佳，而且可以生長，但鈣化的問題仍待解決。
• 英文摘要： No perfect valve or valved conduit is currently available to reconstruct the right ventricular outflowtract (RVOT) in pediatric patients. To investigate the fate of autologous pericardial valved conduit, twentypiglets weighing 12.2±1.4 kg were divided into two groups. In 10 of them, the pericardium was immersedin 0.6% glutaraldehyde for 5 minutes (Gr PG) and then washed with normal saline. In the other 10 pigs, thepericardium was immersed in normal saline only (Gr PN) after procurement. Afterwards the autologouspericardium was tailored as designed to build a tri-cusp-valve inside the pericardial conduit with reconstruc-tion of the sinus of Valsalva. This conduit was connected to the pulmonary trunk (PT) distally and RVOTproximally without a pump. The PT was then doubly ligated just above the annulus. The pigs survived114±92 days in Gr PG and 82±50 days in Gr PN. The body weight increased to 42±29 kg in Gr PGand 30±9 kg in Gr PN. No cusps adhered to the conduit wall in either group. In Gr PN, the valvebecame retracted; in 7 of them an aneurysm developed proximal to the stenotic pulmonary valve, whileonly one pig in Gr PG developed an aneurysm. In Gr PG, the leaflet and conduit showed evidence ofgrowth. In contrast, no evidence of valve growth was found in Gr PN. Calcification was evident morein Gr PG than in Gr PN either on the leaflet (9/10 vs. 5/10) or in the wall of conduit (8/10 vs. 6/10),but the differences were not statistically significant. Histological study showed that the conduit was viablein all pigs, and that the elastic fiber did grow from the PT into the subintimal layer of the pericardialconduit except in one pig of Gr PG. The leaflet was viable in 90% of Gr PG and 60% of Gr PN. Weconcluded that, first, the sinus of Valsalva prevented the adhesion of the pericardial cusp with the vesselwall. Second, the tanned pericardial valved conduit was a better substitute than the nontanned one in termsof its growing potential and eventual integrity in growing pigs.
• 中文關鍵字： autologous pericardial valve; right ventricular outflow tract conduit; growing pig; sinus of Valsalva.
• 英文關鍵字： --