在为新生儿大动脉狭窄而进行气球大动脉膜整形术后,左心的生长,功能和重新干预
Doff B McElhinney1, James E Lock, John F Keane
1Department of Cardiology, Children's Hospital, and Harvard Medical School, Boston, Mass 02115, USA.
Circulation
|February 3, 2005
概括
新生儿跨导管气球大动脉膜整形 (BAVP) 为关键大动脉狭窄 (AS) 提供短期缓解,左心脏结构在一年内正常化. 然而,对于大动脉反 (AR) 或残留AS的重新干预是常见的,尽管大动脉置换是罕见的.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 干预心脏病学 干预心脏病学
- 遗传性心脏病是一种先天性心脏病.
背景情况:
- 过导管气球大动脉膜整形 (BAVP) 是新生儿关键大动脉狭窄症 (AS) 的主要治疗方法.
- 关于新生儿BAVP后的左心发育和再干预模式的数据有限.
研究的目的:
- 评估新生儿BAVP后左心结构的长期生长和功能.
- 分析针对AS用BAVP治疗新生儿的再干预率和结果.
主要方法:
- 在1985年至2002年期间,对113名在<=60天的年龄接受BAVP的患者进行了回顾性分析.
- 早期死亡率的评估,需要单转换,以及短期血液动力学结果 (梯度减小,大动脉吐).
- 对幸存者进行长期随访,以寻找心脏左侧结构的正常化,无需重新干预的生存,以及需要动脉置换的情况.
主要成果:
- 14%的早期死亡率,在晚年显著下降;15%的患者出现显著的大动脉反 (AR).
- 在大多数幸存者中,左心室 (LV) 末端透析尺寸和大动脉环z分数在1-2年内正常化.
- 在5年后,在LV外流通道上无需重新干预的存活率为48%;在5年后,无需大动脉置换的存活率为84%.
结论:
- 新生儿BAVP为AS提供短期缓解,大多数左心结构在一年内正常化.
- 在BAVP后的第一年,对于残留/复发的AS或原性AR的重新干预是常见的.
- 在新生儿BAVP后,在幼儿时期很少需要动脉置换.
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