主动脉缩窄和主动脉弓离断术后婴儿短期随访发生左室流出道梗阻的影响因素分析  

Risk factors for left ventricular outflow tract obstruction after short-term follow-up of repair of coarctation of the aorta and interrupted aortic arch in younger infants

作　　者：邹鹏[1] 李虹[1] 黄景思[1] 许伟滨[1] 饶姣 刘琴[1] 孔娟娟[1] 孙善权[1] ZOU Peng;LI Hong;HUANG Jing-si;XU Wei-bin;RAO Jiao;LIU Qin;KONG Juan-juan;SUN Shan-quan(Department of Cardiac Center,Guangdong Women and Children Hospital,Guangzhou 511442,China)

机构地区：[1]广东省妇幼保健院心脏中心,广州511442

出　　处：《中国循证儿科杂志》2018年第6期417-420,共4页Chinese Journal of Evidence Based Pediatrics

摘　　要：目的探讨小婴儿主动脉缩窄(Co A)和主动脉弓离断(IAA)术后发生左室流出道梗阻(LVOTO)的危险因素。方法纳入2012年3月28日至2017年12月15日在广东省妇幼保健院(我院)心脏中心年龄<6月接受Co A或IAA外科治疗并存活的、且术后随访时间≥12个月婴儿。采用SPSS 20.0软件包行统计学分析。Logistic回归分析Co A和IAA患儿术后出现LVOTO的危险因素。结果 (1)共118例患儿纳入本文分析,男75例。手术年龄的中位数为19(4～150)d,术前平均体重(3.3±0.8)kg,术前平均动脉瓣环(AV)-Z值-0.5±1.2。Co A 95例,其中73例合并室间隔缺损(VSD);IAA 23例,A、B、C、其他类型分别为15、6、1、1例。二叶式主动脉瓣(BAV)23例,三叶式主动脉瓣(TAV) 95例。(2)118例的中位随访时间18(12～81)个月,18例(15.3%)在术后出现主动脉瓣狭窄(AS),其中10例进展为LVOTO,至随访终点时中度AS 8例,重度AS 2例。LVOTO的部位:5例TAV患儿中,3例为主动脉瓣下,2例为主动脉瓣及瓣下;5例BAV患儿中,3例为主动脉瓣,2例为主动脉瓣及瓣下。7例主动脉瓣下狭窄的LVOTO的术后诊断时间为(22.2±14.4)个月,均为隔膜型主动脉瓣下狭窄,6例行主动脉瓣下隔膜(Sub AM)切除术;3例单纯主动脉瓣狭窄的LVOTO患儿的术后诊断时间为(24.0±14.7)个月,均为BAV,在等待手术中。(3)多因素Logistic回归分析提示,BAV是Co A和IAA患儿术后出现LVOTO的危险因素(OR=8.994,95%CI:1.144～70.698)。结论在Co A和IAA <6个月婴儿术后短期随访中即可出现LVOTO,BAV可能是Co A和IAA术后出现LVOTO的危险因素。Objective To investigate the risk factors of left ventricular outflow tract obstruction(LVOTO) after repair of coarctation of the aorta(CoA) and interrupted aortic arch(IAA) in younger infants.Methods Between March 28 2012 and December 15 2017,patients with CoA(n=95)and IAA(n=23)who underwent CoA or IAA repair and survived in Department of Cardiac Center,Guangdong Women and Children Hospital were included,and the postoperative follow-up time should be not less than 12 months.SPSS 20.0 software package was used for statistical analysis.Binary Logistic regression analysis was performed to determine the risk factor of LVOTO in patients with CoA and IAA after repair.Results ① A total of 118 patients were included,and 75 of them were males.The median age at operation was 19 days(4-150 days),average weight before operation was 3.3±0.8 kg,and the average AV-Z score before operation was -0.5±1.2.73 of the 95 patients with CoA combined with ventricular septal defect.Among the 23 patients with IAA,type A,type B,type C and other types were 15,6,1 and 1 respectively.Patients with bicuspid aortic valve(BAV) and tricuspid aortic valve(TAV) was 23 and 95 respectively.② The median follow-up time of the 118 patients was 18 months (12 to 81 months),18 patients had aortic stenosis(AS) after repair,and among them,10 patients progressed to LVOTO.To the end of follow-up,10 patients were with moderate AS,and 2 with severe AS.The location of LVOTO:among 5 patients with TAV,3 was sub-aortic and 2 was sub-aortic and aortic;among 5 patients with BAV,3 was aortic and 2 was sub-aortic and aortic.The postoperative timing of diagnosis for the patients with sub-aortic LVOTO was 22.2±14.4 months,and all of them were sub-aortic membrane(SubAM) AS,and 6 of them underwent resection of SubAM.The postoperative timing of diagnosis for the patients with isolated aortic valve stenosis LVOTO was 24.0±14.7 months,and all of them were BAV waiting for reoperation.③ Multivariable logistic regression analysis identified that BAV(OR=8.994,95%CI:1.144

关 键 词：主动脉缩窄 主动脉弓离断 左室流出道梗阻 二叶式主动脉瓣 主动脉瓣下隔膜 

分 类 号：R726.5[医药卫生—儿科]