重度の先天性心不全のない乳児における両側大動脈弁:初期エコーカルディオグラフィの発見 ガイド 監視戦略
Haley Sherburne1, Rahul Kanade2, Jonathan N Johnson3
1Mayo Clinic, Department of Pediatric and Adolescent Medicine. 200 1st St SW, Rochester, MN, USA 55905.
まとめ
双管大動脈弁 (BAV) と正常な初期エコーカルジオグラムを持つ乳児は,めったに介入を必要としません. 早期の大動脈狭窄または膨張は,将来の大動脈弁および大動脈の問題のリスクが高いことを示し,監視頻度をガイドします.
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病 生まれながらの心臓病
- エコーカルディオグラフィー エコーカルディオグラフィー
背景:
- 二動脈弁 (BAV) は,一般的な先天性心不全 (CHD) である.
- BAVの乳児,特にそれに関連した重大な病変のない乳児に対する監視ガイドラインは,十分に確立されていません.
- この研究は,証拠に基づいたイメージング監視プロトコルの必要性に対処しています.
研究 の 目的:
- 乳児におけるBAVの自然経歴を評価するために.
- 孤立したBAVまたは単純なCHDのBAVを有する乳児におけるバルブ病症およびアオルトパシーの進行頻度を決定する.
- 有害な結果の予測要因を特定し,監視戦略を策定する.
主な方法:
- BAV.を患った乳児 (<1歳) のメイオ・クリニックのエコーカルディオグラフィーデータベース (2001年−2019年) の遡及的検索.
- 含有基準:単離されたBAVまたは単純なCHD (ASD,VSD,PDA) によるBAV. 除外基準:BAVでCHDが有意である.
- エコーカルディオグラムの発見,臨床フォローアップデータ,大動脈弁/大動脈介入の分析.
主要な成果:
- 孤立したBAVまたは単純なCHDのBAVを患った103人の乳児を対象とした.
- 初期エコーカルディオグラムでは,4%が大動脈吐症 (AR),30%が大動脈狭窄症 (AS),35%が大動脈不全症であった.
- ベースラインでASまたはARのない乳児は弁関節介入を受けなかった.ASまたは上昇性大動脈拡張を有する乳児は,介入および進行のリスクがより高かった.
結論:
- 正常に機能するBAVと重度のCHDのない乳児は,生命の初期にバルブ病またはアオートパシーの進行が最小限に示されます.
- ASまたは上昇性大動脈膨張の初期エコーカルディオグラムの発見は,大動脈弁の介入と大動脈病の進行のリスクの増加と関連しています.
- 監視イメージングの頻度は,BAVの乳児における初期弁と大動脈病理によって導かれるべきである.
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