中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

完全性大动脉转位合并左室流出道狭窄患儿接受不同心室内修复手术的回顾性队列研究

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目的 探索接受两种不同的心室内修复术的患儿临床特征和预后水平及其术后不良事件和相关危险因素。 方法 回顾性分析 2012 年 1 月 1 日至 2017 年 1 月 1 日我院 24 例行心室内修复术的完全性大动脉转位(complete transposition of the great arterial, TGA)/左室流出道狭窄(left ventricular outflow obstruction,LVOTO)(TGA/LVOTO)患儿的临床资料。按手术方式将患者分为改良 REV 组和 Rastelli 组。REV 组 13 例,男 9 例、女 4 例,中位月龄 25.2(6,72)个月;Rastelli 组 11 例,男 10 例、女 1 例,中位月龄 47.9(14,144)个月。 结果 REV 组和 Rastelli 组患儿手术时的年龄(P=0.041)、肺动脉瓣环内径的标准 Z 值(P=0.002)和左室流出道峰值压差(P=0.004)、多期手术比例(P=0.005)差异有统计学意义。平均随访时间为 17.3 个月,随访期间有 1 例患儿发生了术后早期死亡,术后早期再干预 2 例,7 例患儿发生了右室流出道狭窄(right ventricular outflow obstruction,RVOTO),且接受 Rastelli 手术(P=0.028),室间隔缺损内径较大(P=0.029)的患儿术后更易发生 RVOTO。 结果 作为 TGA/LVOTO 的传统手术方式,患儿术后早期死亡率很低,早期再干预也较少,改良 REV 术后易出现新构建肺动脉瓣的反流,接受 Rastelli 手术和室间隔缺损较大的患儿易出现术后的 RVOTO,但在平均 17 个月的随访中因术后环肺静脉隔离(PVI)和 RVOTO 造成的远期再干预率很低,故总体预后较好。

Objective To compare the clinical characteristics and prognosis of patients who received two different intraventricular repair. Method We retrospectively analyzed the clinical data of 24 complete transposition of the great arterial/left ventricular outflow obstruction, (TGA/LVOTO) patients who all received intraventricular repair. The patients were allocated into two groups including a REV group and a Rastelli group. There were 13 patients with 9 males and 4 females at median age of 5.2 (6, 72) months in the REV group. There were 11 patients with 10 males and 1 females at median age of 47.9(14, 144) months in the Rastelli group. Result The age at operation (P=0.041), pulmonary valve Z value (P=0.002), and LVOT gradient (P=0.004), rate of between the REV group and the Rastelli group was statistically different. The mean follow up time is 17.3 months. And during the follow up, 1 patients had early mortality, 2 patients had early reintervention, 7 patients had postoperative RVOTO, and received Rastelli and larger VSD inner diameter were associated with postoperative RVOTO. Conclusion As the traditional surgery for TGA/LVOTO patients, the intraventricular repair has a low early mortality and low early reintervention. Modified REV is associated with postoperative peripheral pulmonary vein isolation (PVIS). Patients who received Rastelli operation and with larger VSD inner diameter are more likely to have postoperative RVOTO, but the reintervention for PVI and RVOTO during follow up was very low.

关键词: 完全性大动脉转位; 左室流出道狭窄; 心室内修复术; 预后分析

Key words: Complete transposition of great arterial; left ventricular outflow tract obstruction; Intraventricular repair; prognostic analysis

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