婴儿期左冠状动脉异常起源于肺动脉外科术后随访研究  

Postoperative follow-up study of infants with anomalous origin of left coronary artery from the pulmonary artery

作　　者：刘国文 张红菊 马宁[1] 李静雅[1] 孙妍[1] 马桂琴[1] 郑淋[1] 杨娇 薛丽 王俊 LIU Guowen;ZHAGN Hongju;MA Ning;LI Jingya;SUN Yan;MA Guiqin;ZHENG Lin;YANG Jiao;XUE Li;WANG Jun(Department of Echocardiography,Beijing Children’s Hospital,Capital Medical Uni-versity,Beijing 100191,China)

机构地区：[1]首都医科大学附属北京儿童医院心脏超声科,100191

出　　处：《心肺血管病杂志》2020年第10期1239-1243,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市自然科学基金项目(7192062)。

摘　　要：目的:探讨婴儿期左冠状动脉异常起源于肺动脉(ALCAPA)患儿经外科矫治后心功能恢复及临床预后情况。方法:回顾性分析首都医科大学附属北京儿童医院从2007年6月至2018年8月间,经外科手术治疗的35例ALCAPA患儿超声影像及临床资料。分为两组:≤1周岁的婴儿组,>1周岁的非婴儿组。所有患儿均行术前、术后6个月超声心动图检查及术后长期电话随访。结果:婴儿组22例,其中2例(2/22,9.1%)于术后围手术期死亡。非婴儿组13例,无术后死亡。术前两组患儿相比,婴儿组左心室舒张末期内径指数(LVEDDi)较大,LVEF较低,二尖瓣中量以上反流和二尖瓣腱索及乳头肌回声增强较多(P<0.05)。婴儿组术后6个月与术前相比LVEDDi减小,LVEF增高,二尖瓣反流减少,二尖瓣腱索及乳头肌回声增强减少,室壁运动异常减少(P<0.05)。术后6个月两组患儿相比,婴儿组LVEDDi较大(P<0.05)。两组患儿出院平均电话随访时间5年,无术后再入院及相关心肌缺血事件。结论:婴儿期ALCAPA患儿病情较重手术风险高,但及时手术后近期心功能明显改善。ALCAPA患儿术后5年预后较好。Objective: To investigate the recovery of cardiac function and clinical prognosis in infants with anomalous origin of left coronary artery from the pulmonary artery(ALCAPA) after surgical treatment. Methods: The ultrasound images and clinical datas of 35 children with ALCAPA who underwent surgical treatment from June 2007 to August 2018 in Beijing Children’s Hospital Affiliated to Capital Medical University were analyzed retrospectively. They were divided into two groups: the infant group ≤ 1 year old and the non-infant group>1 year old. All the patients were examined by echocardiography before and 6 months after operation and followed up by telephone. Results: There were 22 cases in the infant group, 2 of them(2/22, 9.1%) died in the perioperative period. No postoperative death occurred in 13 cases of non-infant group. The left ventricular end diastolic diameter index(LVEDDi) was larger, the LVEF was lower, the moderate to severe regurgitation of mitral valve and the chordae tendineae and the papillary muscles hyperechoic of mitral valve were more in the infant group compared to the non-infant group before operation(P<0.05). In the infant group, the LVEDDi decreased, the LVEF increased, the moderate to severe regurgitation of mitral valve and the chordae tendineae and the papillary muscles hyperechoic of mitral valve decreased and the abnormal wall motion decreased 6 months postoperatively(P<0.05). The LVEDDi of the infant group was higher than the non-infant group at 6 months after operation(P<0.05). The average follow-up time of the two groups were 5 years and there was no postoperative readmission and related myocardial ischemia events. Conclusions: The risk of surgical operation is higher in infants with ALCAPA, but the heart function is improved significantly during the early postoperative period. The prognosis of the children with ALCAPA was well after 5 years of operation.

关 键 词：超声心动图 左冠状动脉异常起源于肺动脉 婴儿期 手术预后 

分 类 号：R54[医药卫生—心血管疾病]