主动脉缩窄并心内畸形一期矫治术后效果及中期随访结果分析

Effect of stage 1repair of coarctation of aorta combined with cardiac anomalies and analysis of median follow-up finding

目的总结婴幼儿主动脉缩窄(CoA)并心内畸形一期矫治不同手术方式转归及中期随访结果。方法回顾性分析2013年2月至2016年12月河南省人民医院儿童心脏中心收治的82例CoA并心内畸形患儿,均行一期矫治术。男40例,女42例;手术年龄1个月~8岁[(11.92±22.51)个月];体质量(7.31±6.79)kg;45例并室间隔缺损或房间隔缺损,31例同时并房(室)间隔缺损和动脉导管未闭,5例伴主动脉弓发育不良,7例并复杂心内畸形。手术方式包括端端吻合术、端侧吻合术、补片主动脉成形术等。结果全组术后死亡7例,其中3例因低心排综合征、循环衰竭死亡,1例因循环衰竭、呼吸衰竭死亡,1例术后并发恶性心律失常死亡,2例因呼吸衰竭死亡。患儿术后复查超声心动图均提示无残余梗阻。随访8个月~4年,共随访63例,随访率77%。随访期间无患儿死亡,元动脉瘤发生,5例患儿复查超声心动图出现再缩窄。结论一期矫治CoA并心内畸形术后效果及术后随访效果好,可行性高,远期结果仍需进一步随访。

Objective To summarize the outcomes and the median follow -up finding of stage 1 surgical approaches of coarctation of aorta(CoA)combined with cardiac anomalies.Methods A retrospective study was performed for summarizing the operative and follow-up finding of 82 patients(40 males and 42 females)of CoA combined with cardiac anomalies,who underwent stage 1 repair from February 2013 to December 2016 at the Department of Cardio-vascular Surgery ,Henan Provincial People's Hospital.The operative age was ranged from 1 month to 8 years old[mean (11.92±22.51)months]and the weight was (7.31±6.79)kg.Forty-five cases had ventrieular septal defect (VSD)or atrial septal defect (ASD).Septal defect and patent ductus arteriosus were found in 3.1patients.CoA was associated with aortic arch hypoplasia in 5 patients.Complex cardiovascular deformity was found in 7 cases.The surgical methods included end-to-end anastomosis,end-to-side anastomosis and patch augmentation of the coarctation segment.Results Seven patients died after operation,3 cases of them died of low cardiac output syndrome amd circulatory failure,1 case died of circulatory failure and respiratory failure,1 patient died of malignant arrhythmia,and 2cases died of respiratory failure.Postoperative echocardiogram suggested that anastomosis maintained patency in all the patients. The follow-up time was 8 months to 4 years ,63 patients were followed up ,and follow-up rate was 77%.No death or aneurysm occurred during follow -up period.Recoarctation was found in 5 cases.Conclusions Stage 1 repair for CoA combined with cardiac anomalies is effective,and has low complications during postoperative and median follow-up period.Long -term results need further study.