Bol-Raap G, Weerheim J, Kappetein A P, Witsenburg M, Bogers A J J C
Department of Cardio-Thoracic Surgery, Erasmus MC Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Eur J Cardiothorac Surg. 2003 Oct;24(4):511-5. doi: 10.1016/s1010-7940(03)00430-5.
The purpose of this retrospective study was to assess long-term outcome of children after surgical closure of a ventricular septal defect (VSD).
Between January 1992 and December 2001 a consecutive series of 188 patients (100 females) were operated for closure of a VSD. Temporary tricuspid valve detachment (TVD) was applied in 46 patients (24%) to enhance exposure of the defect using transatrial approach. Pre-operative baseline characteristics showed that the detached group was younger (0.79+/-1.8 vs 2.1+/-3.5 years, p=0.002) and had a lower weight (6.5+/-6.4 vs 10.0+/-11.0 kg, p=0.009).
There was no difference in cross-clamp time (temporary TVD 36.2+/-11.3 vs non-temporary TVD 33.6+/-13.1 min, p=0.228). Postoperative echocardiography showed that 67 patients (36%) had trivial/minimal regurgitation, 10 patients (22%) from the temporary TVD group vs 57 patients (40%) from the non-detached group (p=0.02). There was no tricuspid stenosis. Hospital mortality comprised two patients (1%). One patient died due to a pulmonary hypertensive crisis and one in relation to an acute patch dehiscence for which an emergency reoperation was necessary. At first postoperative echocardiography no shunting was detected in 113 patients, trivial shunting in 73 and significant shunting in none. Multivariate logistic regression analysis revealed that weight at operation was a predictive factor for the occurrence of residual shunting (OR 0.95, C.I. 0.91-0.99). One patient with conduction disturbances needed a permanent DDD-pacemaker. Three patients were lost to follow-up. Mean follow-up time was 2.6 years (range 0.1-9.4). During follow-up no reoperations were necessary for closing a residual VSD. One patient died 7 months postoperative due to a bronchopneumonia. During follow-up in 37 (51%) of the 73 patients the trivial shunting disappeared spontaneously at a median time of 3.9 years. According to actuarial analysis all trivial shunting had disappeared at 8.4 years.
Trivial residual shunting disappeared spontaneously at a median follow-up time of 3.9 years. During follow-up no patient needed to be reoperated for residual VSD. TVD proved to be a safe method to enhance the exposure of a VSD.
本回顾性研究旨在评估儿童室间隔缺损（VSD）手术闭合后的长期预后。
1992年1月至2001年12月，连续188例患者（100例女性）接受了VSD闭合手术。46例患者（24%）采用临时三尖瓣分离术（TVD），通过经心房途径增强缺损暴露。术前基线特征显示，分离组患者年龄更小（0.79±1.8岁 vs 2.1±3.5岁，p = 0.002），体重更低（6.5±6.4 kg vs 10.0±11.0 kg，p = 0.009）。
阻断时间无差异（临时TVD组为36.2±11.3分钟，非临时TVD组为33.6±13.1分钟，p = 0.228）。术后超声心动图显示，67例患者（36%）有轻微/极小反流，临时TVD组10例患者（22%），未分离组57例患者（40%）（p = 0.02）。无三尖瓣狭窄。医院死亡率为2例患者（1%）。1例患者死于肺动脉高压危象，1例死于急性补片裂开，需紧急再次手术。术后首次超声心动图检查发现，113例患者无分流，73例有轻微分流，无显著分流。多因素逻辑回归分析显示，手术时体重是残余分流发生的预测因素（OR 0.95，CI 0.91 - 0.99）。1例有传导障碍的患者需要永久DDD起搏器。3例患者失访。平均随访时间为2.6年（范围0.1 - 9.4年）。随访期间，无需因残余VSD再次手术。1例患者术后7个月死于支气管肺炎。随访期间，73例患者中的37例（51%）轻微分流在中位时间3.9年时自发消失。根据精算分析，所有轻微分流在8.4年时均消失。
轻微残余分流在中位随访时间3.9年时自发消失。随访期间，无患者因残余VSD需要再次手术。TVD被证明是增强VSD暴露的安全方法。
