Objective: To evaluate the predictive value of 3 different risk stratification models including the risk adjustment in congenital heart surgery-1 (RACHS-1), Aristotle basic complexity (ABC), and Society of Thoracic Surgeons-European Association for cardiothoracic surgery congenital heart surgery mortality score (STAT) risk scoring system for death and major complications in patients after congenital heart surgeries. Methods: A total of 3 578 patients (age<18 years old) received surgery for congenital heart diseases from January to December 2015 in Fuwai hospital were enrolled, and the clinical data were retrospectively analyzed. The congenital heart disease patients were 1.7 (0.8, 4.5) years old, and the male accounted for 54.3% (1 943 cases).Death after surgery and major complications including use of extracorporeal membrane oxygenation, bedside thoracotomy, peritoneal dialysis for renal failure, bedside hemofiltration for renal failure, tracheotomy, reoperation for mediastinum infection, reoperation for heart in hospital were observed. The area under the receiver operating characteristic (ROC) curve was calculated to evaluate the predictive value for mortality after surgery and major complications with RACHS-1, ABC, and STAT risk scoring systems. Results: The mortality after surgery was 0.4% (14/3 578) , and the rate of major complications was 3.2% (113/3 578) . For mortality after surgery, areas under the ROC curve were 0.682 (95%CI 0.570-0.795, P=0.002), 0.722 (95%CI 0.612-0.832, P<0.001), and 0.753 (95%CI 0.659-0.847, P<0.001) with RACHS-1, ABC and STAT risk scoring systems, respectively. For major complications, areas under the ROC curve were 0.709 (95%CI 0.667-0.751, P<0.001), 0.743 (95%CI 0.702-0.784, P<0.001), and 0.731 (95%CI 0.693-0.770, P<0.001) with RACHS-1, ABC and STAT risk scoring systems, respectively. Conclusion: STAT risk scoring system is superior to RACHS-1 and ABC risk scoring systems on predicting death after surgery, and ABC risk scoring system is superior to RACHS-1 and STAT risk scoring systems on predicting major complications in Chinese patients with congenital heart disease in the single center.

目的 评估新型口服抗凝剂在接受第二代冷冻球囊消融术的老年心房颤动(房颤)患者中的有效性和安全性.方法 选取2016年8月至2018年6月中国医学科学院阜外医院收治的接受冷冻球囊消融术的老年房颤患者101例,根据口服抗凝药物的种类将其分为利伐沙班组(42例)和达比加群酯组(59例),比较两组患者用药的安全性和有效性.结果 术中及术后3个月内,共12例(11.9％)患者发生出血事件.两组患者发生主要出血事件的风险比为1.4(95％CI:0.28～7.5,P=0.691),发生次要出血事件的风险比为2.79(95％CI:0.52～17.21,P=0.230);两组患者发生血栓栓塞事件的风险比为0.7(95％CI:0.06～7.93,P=1.000).共有11例(91.67％)出血事件发生在消融术后48 h内,而1例(8.33％)发生在消融术至少7 d后.结论 在接受第二代冷冻球囊消融术的老年房颤患者抗凝治疗中,利伐沙班与达比加群酯的抗凝效果相当,且安全性均较高.

目的 评估伊布利特在行冷冻消融术后仍为持续性房颤(简称房颤)患者中的转复疗效及安全性.方法回顾分析单中心收治应用冷冻球囊消融治疗持续性房颤消融术后仍为房颤,并于术中应用伊布利特转复的患者临床资料,包括临床基线特征 、术中QTc间期改变值 、冷冻程序结束时的A-A间期及并发症,术后随访包括房颤复发和其它心血管事件.结果33例行冷冻球囊消融的持续性房颤患者入组,在冷冻消融程序结束时均保持为房颤,应用了伊布利特静脉输注.20例在伊布利特输注结束20 min内房颤终止,13例仍需要同步直流电复律转复窦性心律,伊布利特的转复成功率为60.6％.转复窦性心律后的QTc间期较输注伊布利特前明显延长[(455±81)ms vs(381±46)ms,P<0.001],4例出现血流动力学障碍的并发症(12.1％),均发生于房颤终止转复窦性心律之时或之后,其中3例转复窦性心律后的QTc间期发生了明显的延长.与伊布利特复律失败组相比,伊布利特转复成功组的患者房颤病程更短[(17.4±14.7)个月vs(55.8±59.6)个月,P=0.04],而冷冻程序结束时的平均AA间期长于复律失败组[(251±20)ms vs(221±36)ms,P=0.004].术后1年内75.8％ 的患者能维持窦性心律.结论 伊布利特可对冷冻球囊消融术后仍为持续房颤的患者有效地转复窦性心律,但会延长患者的QTc 间期.伊布利特转复成功的患者房颤病程更短,而冷冻消融程序结束时的A-A 间期更长.

干细胞是一种具有自我更新能力和多向分化潜能的细胞.干细胞的广泛应用为细胞治疗各类疾病提供了新的解决思路和研究方向.该文主要讲述间充质干细胞(MSC)、多潜能干细胞(PSC)、癌症干细胞(CSC)在细胞治疗领域中的研究现状与展望.

目的 有毒醛的堆积可产生心血管毒性,乙醛脱氢酶2(ALDH2)可有效清除醛类物质,本研究旨在兔心肺转流(CPB)模型中探索ALDH2活化的心肌保护作用.方法 21只新西兰白兔随机分为三组:CPB不停跳组(C组)、停跳组(CA组)、停跳+Alda-1组(CAA组),Alda-1为ALDH2特异性激动剂,另随机选取21只作为供血兔.右腋动脉插管及右房插管建立CPB模型,主动脉阻断120 min后开放,生命体征平稳后停机,恢复心肌灌注120 min测定心功能并取左室心肌组织,测定ALDH2的含量及活性、4-羟基壬烯醛(4-HNE)含量、丙二醛(MDA)含量、氧化型与还原型谷胱甘肽比值(GSH/GSSG)、蛋白羰基含量,检测不同时点血气及血清肌酸磷酸激酶同工酶(CKMB)值.结果 各组间ALDH2含量无明显差异,CAA组与CA组相比ALDH2活性明显增加(P<0.001),4-HNE、MDA含量在CA组较C组增加(4-HNE:P<0.001,MDA:P=0.001),CAA组较CA组明显下降(4-HNE:P=0.013,MDA:P<0.001).CAA组较CA组心肌蛋白羰基水平、血清CKMB明显降低,GSH/GSSH生成增加(P<0.05),CAA组左室压力形成最大速率较CA组明显升高(P=0.040),但三组间左室舒张末压、左室收缩末压、左室压力形成最小速率无统计学差异.结论 CPB期间ALDH2活化可加强有毒醛清除,增强心肌抗氧化损伤能力,减轻心肌的氧化应激,改善心肌收缩功能.

Background Cryoballoon ablation has been demonstrated to be an effective way for the treatment of atrial fibrilation（AF）. However,in the population with high risk of thromboembolism, long-term oral anticoagulants are still in need, which lead to the odds of hemorrhage. As

患者,男性,71岁,阵发性心房颤动5年,入院前6个月内反复脑卒中2次.在接受冷冻球囊进行肺静脉电隔离术同时完成经皮左心耳封堵术,短期临床随访无心房颤动复发及新发栓塞事件.

Objective To describe and analyze the key points of applying the cryoballoon ablation to atrial fibrilai ton trigged by superior vena cava (SVC) after the regular cryoballoon-based pulmonary vein isolation.Method A total of four patients were included in this study,who were all diagnosed atrial fibrillation and treated by cryoballoon ablation of the second generation.After all pulmonary vein potentials were isolated,we placed the cryoballoon into the ostium of SVC for ablation.We collected the information in these operations,and followed up all of four patients 3 months later after the operations.Results All of the four patients were males,two of whom were diagnosed paroxysmal atrial fibrillation,another two with continuous atrial fibrillation.The potentials in SVC had achieved isolation in (36.3± 19.3) seconds at the first ablation in SVC in all of them.The temperature in the SVC reached (36.3±19.3)s at the moment of isolation.The total time in SVC ablation were (61.8±26.9)s,and the minimum temperature were (-40.5± 4.4)℃.There were no serious complications,such as hemodynamic changes,vasovagal reflex,phrenic nerve paralysis,sinus bradycardia,or perforations.And no atrial tachycardia recurred 3 months after the operations.Conclusion From our experience,it can be safe and effective to apply the cryoballoon ablation in SVC to treat atrial fibrillation.

Objective To observe neuropsychological development status in children after surgical treatment of congenital heart diseases(CHDs)and analyze the risk factors. Methods 89 children who received outpatient review in Fuwai Hospital from September 2015 to March 2016 after surgical treatment of CHDs were recruited in this study and 90 normal children were recruited as the control group. The children with CHDs were divided into simple CHDs group(RACHS- 1 score≤2)and com-plex CHDs group(RACHS- 1 score≥3)according to RACHS- 1 classification. Neuropsychological development status was meas-ured according to pediatric-psychological mental test scale developed by Capital institute of pediatrics,Beijing and statistical a-nalysis was compared. Results The measurements of neuropsychological development showed the normal children behaved better than the children with CHDs(P < 0. 05). The simple CHDs group achieved better distribution of development quotient than complex CHDs group(P = 0. 032)and there was no difference between the normal control group and simple CHDs group (P = 0. 420). Multivariate regression analysis indicated that younger age at cardiac surgery,lower preoperative blood urea ni-trogen(BUN),higher preoperative creatinine(Cr)and prolonged duration of cardiopulmonary bypass(CPB)accounted for low-er scores in the test scale(P < 0. 05). Conclusion Distinct neuropsychological difficulties could be present especially in chil-dren with complex CHDs. Younger age at cardiac surgery,preoperative BUN,Cr and CPB duration were perioperative factors that were associated with long-time neuropsychological development.

Objective To investigate the feasibility of atrial fibrillation( AF) canine model that is made by the high frequency stimulation with abandoned implantable cardioverter defibrillator(ICD). Methods Six canines were implanted with pacing electrode in right atrium or/and right ventricular through right internal jugular vein under general anesthesia. The ICD generator was buried under the back of neck,and connected with the pacing electrode by the subcutaneous tunnel. High frequency stimulation with 50Hz was remotely released with programmable instrument. AF events were recorded in ICD and calculated after every stimulation to evaluate the inducing capability of high frequency stimulation. Paroxysmal AF was defined as AF lasting for 2-30 minutes, and persistent AF was defined as AF lasting for more than 30 minutes. Results All 6 canines were successfully implanted with pacemaker system, and 5 of 6 were successfully made with AF model. Paroxysmal AF model was archived with mean 18(12, 25) stimulations on mean 3.6(3, 5) days. Persistent AF model was archived with mean 97(83,117) stimulations on mean 18.6(15, 20) days. Conclusion Canine AF model can be established successfully by high frequency stimulation with abandoned implantable cardioverter defibrillator, which have the advantages of simple method and practical economy.

Objective To investigate the safety and effectiveness of second generation balloon cryoablation for paroxysmal atrial fibrillation.Methods A total of 112 patients with paroxysmal atrial fibrillation were received cryoablation with the second generation cryoballoon.The cryoablation related parameters of every pulmonary vein (PV) and complications were collected.The regular clinical follow-ups were carried out after 3 months of blank period.The recurrence was defined as atrial fibrillation or atrial flutter or atrial tachycardia which lasting for ≥ 30 s during follow-up.Results The success rate of cryoablation for paroxysmal atrial fibrillation was 86.6％ during mean 9 (5,16) months follow-up period.In a total of 452 PVs cryoablation,the mean times of cryoablation were 2 (1,3),the mean lowest temperature were-47 [-36,-57] ℃.The mean minimum temperature in the bilateral superior pulmonary veins (LSPV:-49 ℃ ± 5 ℃,RSPV:-50 ℃ ± 6 ℃) was lower than that in the inferior ones (LIPV:-43 ℃ ± 5 ℃,RIPV:-45 ℃ ± 3 ℃),P＜0.01).52.9％ PV were isolated during the first cryoablation,96.2％ PVs finally reached PVI.The rate of PVI was higher in the LSPV than in RSPV (P=0.012 6) and RIPV (P＜0.000 1),and higher in the LIPV than in RIPV (P＜0.000 1) during the first cryoballoon ablation.However,the total PVI rates were not different among these pulmonary veins.The perioperative complication rate was 7.1％,of which 5 (4.5％) patients had phrenic nerve injury,and only 1 patient had phrenic nerve palsy.Conclusion Cryoablation for paroxysmal atrial fibrillation with second generation cryoballoon is safe and effective.Phrenic nerve injury is still one of the major complications.

目的 探索心房颤动(简称房颤)患者在导管消融围手术期间,短期启动利伐沙班抗凝治疗的有效性及安全性.方法 入选151例在阜外医院单中心行射频或冷冻导管消融治疗的非瓣膜性房颤患者,根据入院前抗凝情况分为两组:华法林组:术前不间断口服华法林4周以上,并维持国际正常化比率(INR)在2.0～3.0之间(n=56);利伐沙班组:术前3天启动利伐沙班口服抗凝(n=95).观察的主要终点事件为血管穿刺后至术后48 h发生的血栓及栓塞事件,次要终点包括大出血事件和/或小出血事件.结果 利伐沙班组和华法林组的年龄[(56.2±9.8)和(60.1±7.8)岁,P=0.011]、CHA2DS2-VASc评分(1.6±1.3和2.2±1.6,P=0.015)和HAS-BLED评分(1.42±1.23和2.02±1.24,P=0.005)存在差异,但左房前后径、体重指数、左室舒张末径和左室射血分数等基线指标均无统计学差异;术中活化凝血时间相比无统计学差异[(242.7±42.8)s和(235.9±58.0)s,P=0.414].观察终点:利伐沙班和华法林组在围手术期血栓栓塞事件(1.1％和0,P=1.000)、大出血事件(1.1％和1.8％,P=1.000)和小出血事件发生率(2.1％和5.4％,P=0.360)方面无统计学差异.结论 房颤患者于导管消融术前短期启动利伐沙班抗凝的方案有效且安全.

Objective To explore the efficacy and safety of short-term initiation of a new type of oral anticoagulants in perioperative period of ablation for atrial fibrillation.Methods The 97 patients with non-valvular atrial fibrillation (72 patients with paroxysmal atrial fibrillation and 25 patients with persistent atrial fibrillation) who underwent catheter ablation at the single center of Fuwai Hospital of the Chinese Academy of Medical Sciences were retrospectively analyzed.According to the anticoagulant situation,they were divided into two groups:34 patients in the converntional group who received more than 3 weeks uninterrupted dabigatran;and 65 patients in short-term group who received 3 days before ablation.The primary endpoint was the thrombotic and embolic events occurred from vascular puncture to 48 h postoperative.Secondary endpoints included major bleeding and/or minor bleeding events.Results There was no statistical significance on baseline characteristics between the short-term and conventional groups including age [(59.0 ± 9.1) years old vs.(58.8 ± 10.4) years old,P =0.915],CHA2DS2-VASc score (2.5±2.0 vs.2.5 ± 1.8,P=0.956)and HAS-BLED score(1.2±0.9 vs.1.2±0.8,P=0.821).No thrombotic,embolic events,or major bleeding occurred in all patients.There were 3 minor bleeding events which is inguinal ecchymosis or hematoma in the short-term group and 5 in the routine group,but there was no significant difference(4.6％ vs.15.6％,P =0.110).Conclusions It is effective and safe to initiate short-term new oral anticoagulant therapy in perioperative period of ablation for atrial fibrillation.

Objective:To determine whether the injection sites of myocardial infarcted area had a various effect on the bone marrow mesenchymal stem cells (BMSCs) survival and efficacy of cell transplantation. Meth-ods:Myocardial infarction (MI) was induced by left anterior descending artery ligation in female rats. 3 weeks after MI, 3×106bromodeoxyuridine (Brdu) labeled male BMSCs were directly intramyocardial injected into the borderline (BZC group) or central zone (CZC group) of the MI area. In the control groups, the same volume of phosphate buffered saline (PBS) was injected into the borderline (BZP) or the central zone of the myocardial in-farction (CZP), respectively. Cell survival at the 24 hours and 4 weeks after transplantation was assayed by quan-titative real-time PCR to identify Y chromosome gene. Heart function was evaluated by echocardiography before and after cell transplantation. Ventricular remodeling was analysis by using HE staining with measurement of the expansion index and scar thickness. Cell transplantation induced angiogenesis was tested by VIII factor staining. Results:The detectable transplanted cell survival rate in the BZC group were significantly higher than that of CZC group both at the time of 24 h (15.74%±4.13% vs. 8.2%±2.63%, P＜0.01) and 4 weeks (5.57%±1.13% vs. 1.72%±0.41%, P＜0.01) after cell transplantation. Compared with the CZC group, improvement of left ventricular ejection fraction (LVEF) and fractional shortening (P＜0.05, respectively) were observed in BZC group. Addition-ally, BMSCs transplanted in the borderline zone also induced augmentation of capillary density than that in the CZC group (P＜0.01). Left ventricular remodeling (scar thickness expansion index) in BZC group was significant-ly improved (P＜0.01), and no improved expansion index was identified in CZC group. Conclusion:Borderline area was more suitable than central zone of MI for the survival of the transplanted cells and thereby promoted the angiogenesis and restored the damaged heart function.

目的 通过观察非瓣膜病性心房颤动(简称房颤)合并心房血栓患者的临床特征及其溶栓治疗效果,探讨心脏基础疾病对心房血栓位置和溶栓效果的影响.方法 回顾性分析本院初次诊断为心房血栓的非瓣膜病性房颤患者的病历资料.通过住院病历资料提取临床特征、心房血栓部位、确诊前抗凝治疗情况、确诊后抗栓治疗方案,计算CHADS2和CHA2DS2-VASc积分.根据患者临床随访的影像学检查结果判断血栓是否溶解并计算血栓溶解时间.根据患者是否合并心肌病分为心肌病组和非心肌病组.结果 共入选78例,心房血栓部位分布表现:53例(67.9％)仅见于左心耳,5例(6.4％)仅见于左房,17例(21.8％)左房和左心耳同时存在,3例(3.9％)仅见于右房.心肌病组(n=38)单纯左心耳血栓发生比例低于非心肌病组(52.6％ vs 62.3％,P=0.0047),右房血栓均为心肌病组患者.CHA2DS2-VASc积分识别高危(≥2分)患者能力高于CHADS2积分(80.8％ vs 38.5％,P＜0.0001).确诊前30.9％未抗栓治疗,21.8％仅仅口服阿司匹林;42.3％口服华法林,其中仅有7.7％患者国际正常化比值≥2.0;5.1％口服新型抗凝药物.72例(92.3％)患者抗栓治疗后平均(6.5±4.2)个月的随访中重复同样检查,其中51例(71.8％)证实血栓溶解.心肌病组血栓溶解成功率低于非心肌病组[60％(21/35) vs 81.1％(30/37),P=0.028 9].Logstic回归分析证实心肌病能独立预测溶栓治疗效果(OR=-1.20±0.56,P=0.043 6).结论 左心耳仍是非瓣膜病性房颤患者心腔内血栓形成最常见的部位,但心肌病患者更易发生心房内血栓.抗凝治疗认识不足和治疗不规范与血栓形成密切相关.CHA2DS2-VASc积分进行血栓风险评估优于CHADS2积分.心肌病是预测溶栓治疗效果的独立危险因素.

目的 探讨心房颤动(简称房颤)冷冻消融术后空白期内房性心律失常发作特点及其与远期随访效果的关系.方法 51例症状性房颤患者接受第一代冷冻球囊的冷冻消融.术前经胸超声测定左房前后径.术后3个月内采用心电事件记录仪进行远程心电监测,之后每隔3个月进行包含24 h动态心电图和/或心电图在内的门诊随访.复发定义为心电图和/或24 h动态心电图和/或远程心电监测发现快速性房性心律失常(房颤或心房扑动或房性心动过速)发作持续时间＞30 s.根据空白期内随访结果分为早期复发组和无复发组.根据术后12个月的长期随访结果分为晚期复发组和无复发组.结果 所有患者均完成12个月临床随访,冷冻消融成功率为70.6％.晚期复发组左房内径较大[(41.2士4.3)mm vs (36.5±4.2)mm,P=0.0006]、糖尿病比例较高(33.3％ vs 5.56％,P=0.0086).晚期复发组空白期内快速性房性心律失常发生率高于晚期无复发组(27.7％ vs 2.4％,P＜0.001).晚期无复发组空白期第1～3个月快速性房性心律失常事件发生率依次为5.9％、0.7％、0.1％,而晚期复发组则依次为30.0％、28.4％、24.9％.23例(45.1％)患者出现早期复发,以持续性房颤患者较多(34.8％ vs 10.7％,P=0.0376).早期复发组中13例(56.5％)出现晚期复发,10例(43.5％)表现为晚期无复发,而早期无复发组仅有2例(7.1％)患者出现晚期复发.多元回归分析显示早期复发(RR =58.8,P=0.001)、糖尿病(RR=18.5,P=0.021)和左房内径(RR=1.4,P=0.002)是预测晚期复发的独立危险因素.结论 冷冻消融术后空白期内早期复发是一个常见的现象,主要发生在术后第1个月内.早期复发并不等于晚期复发,但早期复发患者具有较高的晚期复发风险.

患者男性,78岁,因阵发性心房颤动(简称房颤)在接受冷冻球囊进行肺静脉电隔离术中转为典型心房扑动(简称房扑),遂将冷冻球囊放置三尖瓣峡部进行冷冻消融并成功终止房扑,起搏证实峡部双向传导阻滞.临床随访无房颤、房扑复发.

Objective To recognize the risk factors of unplanned re-interventions within 30 days after pediatric cardiac surgery and evaluate the outcome of re-interventions. Methods We retrospectively analyzed the clinical data of 202 children in Fuwai Hospital between January 1, 2015 and August 31, 2017. There were 115 males and 87 females at average age of 32.4 months with range of 3 days to 14 years. Results There were 202 children who underwent unplanned re-intervention during 30 days post-operation, including 54 re-adjustments of pulmonary blood flow, 34 re-corrections for residual cardiac abnormalities, 28 cardiopulmonary resuscitations, 38 for coagulation problems, 19 pericardial drainages, 11 palliative re-operations to deliver heart load and 6 diaphragmatic folds and 12 others. The mortality rate among children who underwent unplanned re-inventions after cardiac surgery was 10.9％ (22/202). It was much higher than those free from re-interventions (0.7％). Time of mechanical ventilation was 284.3 (11-2 339) h, and mean ICU stay was 17.7 (1-154) d, significantly longer than those free from re-interventions at the same period. Conclusion Unplanned reinterventions after pediatric cardiac surgery is associated with higher mortality rate and longer recovery time. Early identifying risk factors and re-intervention can reduce the complications and improve the prognosis.

目的:总结自制三瓣叶Goretex管道在先天性心脏病(先心病)患儿右心室流出道重建中的近期结果.方法:2016-12至2017-06期间采用自制三瓣叶Goretex管道重建右心室流出道患儿19例,平均年龄(5.9±3.6)岁,平均体重(20.2±8.2)kg.根据患者年龄和体重,制定右心室流出道的直径目标值,将0.1 mm Goretex膜剪裁三片相同大小的椭圆形作为瓣叶,6/0 prolene线单纯连续缝合至Goretex管道,自制成三瓣叶Goretex管道.采集患儿出院时超声心动图评价带瓣管道内瓣口狭窄和反流程度情况,出院后1个月门诊超声心动图复查随访观察.结果:右心室双出口6例,矫正型大动脉转位4例,肺动脉闭锁4例,大动脉转位2例,共同动脉干1例,双根部调转术后外管道狭窄1例,主动脉瓣狭窄1例.单纯Rastelli术8例,Rastelli+Senning术1例,Rastelli+半Mustard术2例,Rastelli+上腔静脉右心房连接术(Glenn take down)2例,Rastelli+双侧双向Glenn例1例,右心室肺动脉外管道置换术3例,Ross术1例,共同动脉干矫治术1例;其中二次手术12例(63.2％).手术均在体外循环下完成,术后常规阿司匹林(3 mg/kg口服QD)抗栓,全组患者无院内死亡和严重并发症发生,出院及随访时间1个月时超声心动图显示所有患者肺动脉瓣口均无狭窄,2例(10.5％)患者肺动脉瓣轻度反流,其余患者无反流.结论:自制三瓣叶Goretex管道重建先心病右心室流出道近期结果满意,但中远期结果需要进一步随访.

目的:探索肺动脉瓣置换术(PVR)治疗法乐四联症矫治术后合并重度肺动脉瓣反流的效果.方法:回顾性分析2014-01至2017-02在我院行外科PVR治疗法乐四联症术后合并肺动脉瓣大量反流的24例患者的临床结果.结果:24例患者PVR手术时年龄(24.4±12.6)岁,患者行PVR与行法乐四联症矫治手术的平均间隔时间为(14.6±7.3)年.(1)围手术期结果:平均体外循环时间(182.5±75.4)min,平均主动脉阻断时间为(109.8±44.6)min(n=18,75％);同期三尖瓣成形10例(41.7％),瓣膜置换包括12例同种瓣,12例生物瓣.(2)手术结果:无院内死亡,平均住院时间为(15.2±5.5)天.(3)随访:平均随访(1.1±0.8)年,出院后无死亡及再手术等重大并发症,1例肺动脉瓣功能衰竭.PVR后右心室容积显著减小[手术前后右心室舒张末期容积指数:(190.5±29.8)ml/m2 vs(109.2±19.0)ml/m2,P<0.001;右心室收缩末期容积指数:(135.3±28.5)ml/m2 vs(80.0±11.3)ml/m2,P<0.001],而左心室容积、左心室射血分数、峰值耗氧量、QRS间期等改变差异均无统计学意义.末次随访超声检查发现,三尖瓣中量反流4例,肺动脉瓣大量反流1例、中量反流4例.结论:PVR可有效缩小法乐四联症矫治术后患者扩张的右心室,提高最大运动负荷,远期仍需进一步随访.