通过补丁增强进行门重建后的大动脉生长:二十年的经验
Dominic P Recco1,2, Shannen B Kizilski1,2, Reena M Ghosh2,3
1Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA.
Interdisciplinary cardiovascular and thoracic surgery
|December 22, 2023
概括
最佳的大动脉门重建尺寸是长期增长的关键. 在z-score0和+1之间进行初始重建,可确保中期大动脉尺寸正常,并降低重新干预的风险,特别是在大动脉峡.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 生产性心脏手术 手术 生产心脏手术
- 血管生物学 血管生物学
背景情况:
- 大动脉门的重建对于先天性心脏缺陷至关重要.
- 对于大动脉门重建的最佳初始尺寸尚未确定.
- 过小或过大可以导致不良结果.
研究的目的:
- 在补丁增强门重建后分析纵向大动脉生长.
- 为了确定正常的中期尺寸的理想初始重建的大动脉尺寸.
- 确定影响大动脉生长和重新干预风险的因素.
主要方法:
- 54名接受达姆斯-卡耶-斯坦塞尔 (Damus-Kaye-Stansel,DKS) 或非DKS门重建 (2000-2021) 的婴儿的回顾性评估.
- 通过心声学和横截图成像测量大动脉尺寸 (上升大动脉,横弧,大动脉峡,下降大动脉).
- 对大动脉尺寸和z分数的纵向变化进行分析,其次要结果包括再干预率.
主要成果:
- 所有大动脉段显著增长,稳定的z-score,除了非DKS近端和远端横梁.
- 非DKS患者的初始大动脉峡 (AIsth) z-score < -1 的最终AIsth尺寸较小.
- 在z分数0和+1之间的初始重建中,在中期随访时保持了这些维度.
结论:
- 补丁增大允许比例的大动脉生长,当最初大小为正常的z-scores时.
- 大动脉峡 (AIsth) 的不足是常见的,并且与更高的再干预率有关.
- 针对性的初始大动脉大小测量,特别是对于AIsth,对于最佳的中期结果和减少重新干预至关重要.
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