在中断的大动脉门修复后,左心室外流通道的命运
Shuhua Luo1, Paul H Schoof2, Edward Hickey3
1Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China.
World journal for pediatric & congenital heart surgery
|July 25, 2024
概括
新生儿中断的大动脉门修复需要仔细考虑左心室外流通道阻塞 (LVOTO) 风险. 罗斯-康诺和亚苏伊手术有效地缓解了晚期LVOTO,而切除则带来了最高的再干预风险.
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
- 心血管外科心血管外科
背景情况:
- 间断大动脉门 (IAA) 是一种严重的先天性心脏缺陷,通常与左心室外流通道阻塞 (LVOTO) 相关.
- 新生儿IAA的修复需要策略来解决潜在的LVOTO,并减少重新干预的需要.
研究的目的:
- 评估新生儿中断大动脉门 (IAA) 修复后左心室外流通道 (LVOT) 重新干预的概率.
- 为了比较不同手术方法在减轻长期LVOTO风险方面的有效性.
主要方法:
- 在2003年至2017年期间,对150名接受IAA修复的新生儿进行了回顾性多中心研究.
- 分析包括孤立的IAA修复和与同时进行LVOT干预的修复 (状肌肉切除,罗斯-康诺,亚苏伊手术).
- 多变量分析探讨了与LVOT重新操作相关的因素.
主要成果:
- 在Ross-Konno (100%),Yasui (77%) 和孤立的IAA修复 (77%) 之后,五年免受LVOT重新操作的时间最高.
- 同时的切除是最少的免于重新操作 (47%),并在随访时显示LVOT梯度增加.
- 罗斯-科诺和亚苏伊手术与更高的右心室外流管 (RVOT) 重新手术率有关,但没有影响生存率.
结论:
- 亚苏伊和罗斯-科诺的操作都有效地减少了IAA修复后的LVOTO风险.
- 状肌肉切除与LVOT重新干预的风险最高,而罗斯-康诺的风险最低.
- 虽然RVOT重新操作在Ross-Konno和Yasui之后更常见,但它似乎不会影响生存.
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