Isomatsu Y, Imai Y, Shin'oka T, Aoki M, Iwata Y
Department of Pediatric Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan.
J Thorac Cardiovasc Surg. 2001 Apr;121(4):792-7. doi: 10.1067/mtc.2001.112834.
Few studies after surgical repair of the anomalous origin of the left coronary artery have reported the importance of the mitral annuloplasty or the long-term results.
Between January 1982 and March 2000, 29 patients with anomalous origin underwent surgical intervention at our institution (direct aortic reimplantation in 19 and Takeuchi procedure in 10). Age at the time of operation ranged from 2 months to 24 years (median, 29.3 months), and 9 patients were infants. Twenty-four patients had varying degrees of mitral incompetence. Simultaneous mitral annuloplasty at the anterolateral commissure was performed in all 24 patients with incompetence.
There were 2 hospital deaths among the infants, and no late deaths. Mean follow-up was 100 +/- 57 months, and the actuarial survival was 93.1% at 10 years (70% confidence limits, 87-99). Cardiothoracic ratio at discharge was not decreasing significantly (P =.35); however, this value 5 years after the operation showed the significant decrease (P =.003) versus preoperative value. Preoperative mitral incompetence decreased in all but one of the operative survivors with mitral annuloplasty at the last follow-up. The left ventricular fractional shortening z-score was not normalized at discharge but was normalized in the late period.
These data demonstrate that impaired left ventricular function normalized in the long term (even if it was below normal immediately after operation) after 2-coronary repair. We recommend that the simultaneous mitral annuloplasty should be performed at the time of operation for patients who have mitral incompetence with anomalous origin of the left coronary artery.
关于左冠状动脉异常起源手术修复后的研究，很少有报道提及二尖瓣环成形术的重要性或长期结果。
1982年1月至2000年3月期间，29例左冠状动脉异常起源患者在我院接受了手术干预（19例行直接主动脉再植入术，10例行竹内手术）。手术时年龄从2个月至24岁不等（中位数为29.3个月），9例为婴儿。24例患者有不同程度的二尖瓣反流。所有24例有反流的患者均在外侧前联合处同时进行了二尖瓣环成形术。
婴儿中有2例住院死亡，无晚期死亡。平均随访时间为100±57个月，10年时的精算生存率为93.1%（70%可信区间，87 - 99）。出院时心胸比率无显著下降（P = 0.35）；然而，与术前值相比，术后5年该值有显著下降（P = 0.003）。除1例手术存活者外，所有接受二尖瓣环成形术的手术存活者在最后一次随访时术前二尖瓣反流均有所减轻。左心室短轴缩短率z评分在出院时未恢复正常，但在后期恢复正常。
这些数据表明，双冠状动脉修复后左心室功能受损在长期内（即使术后即刻低于正常）可恢复正常。我们建议，对于有二尖瓣反流的左冠状动脉异常起源患者，手术时应同时进行二尖瓣环成形术。
