動脈スイッチ操作後の大動脈の根の拡張と大動脈の再発の長期的な予測要因
Marcy L Schwartz1, Kimberlee Gauvreau, Pedro del Nido
1Department of Cardiology, Children's Hospital, 300 Longwood Avenue, Boston, Mass 02115, USA. Marcy.Schwartz@cardio.chboston.org
Circulation
|September 15, 2004
まとめ
新大動脈の根の拡張と再発は,大動脈のd-ループ転移のための動脈スイッチ操作後に発生する可能性があります. 前回の肺動脈帯化と手術時の高齢化は,これらの合併症の危険因子です.
科学分野:
- ペディアトリック・カルディオロジー
- 生まれながらの心臓手術 生まれながらの心臓手術
- 心臓画像検査 (Cardiac Imaging) について
背景:
- 新大動脈の根の拡張 (ARD) と新大動脈の再発 (AR) は,大動脈のd-ループ転移 (dTGA) の動脈スイッチ操作 (ASO) の後の長期的な合併症である.
- ARDとARの予測要因を特定することは,ASO後の患者のアウトカムを改善するために重要です.
研究 の 目的:
- 大動脈のdループ転移 (dTGA) の患者で,動脈スイッチ手術 (ASO) の後の新大動脈根拡張 (ARD) と新大動脈吐 (AR) の独立した予測要因を特定する.
主な方法:
- 2001年以前にDTGAに対するASOを受け,2001年より前に無傷の心室隔膜またはVSDを有する335人の患者の遡及的分析.
- 含有基準:ASO後1年以上の少なくとも1回の術後のエコーカルディオグラム,以前の心房切り替えの手術なし.
- カプラン・マイヤー分析とコックス比例リスクモデリングを用いて予測要因を特定した.
主要な成果:
- ARD のない確率は10年後に51%であったが,ARD は後期フォローアップでは進行しなかった.
- 以前の肺動脈帯 (PAB) と後のASOの時間帯は,ARDの独立した予測者でした.
- ASO (>1年) での高齢化,VSDの存在/修復,および以前のPABは,中等度または重度のARの危険因子でした.
結論:
- ASOの後,時間の経過とともに有意なARDとARが発達しますが,ARDは一般的に漸進的ではありません.
- 前 PABは,ARDの重要な危険因子です.
- ASO,VSD,および以前のPABでの高齢化は,ARの危険因子であり,密接な監視を必要とします.
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