Tchervenkov Christo I, Jacobs Jeffrey P, Sharma Kapil, Ungerleider Ross M
Division of Pediatric Cardiovascular Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montréal, Quebec, Canada.
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2005:92-102. doi: 10.1053/j.pcsu.2005.01.023.
Interrupted aortic arch (IAA) is defined as the loss of luminal continuity between the ascending and descending aorta. It is associated with a multitude of lesions ranging from isolated ventricular septal defects to complex ones. Although results have improved in the modern era, repair of IAA is associated with a significant mortality and morbidity. In recent years, the move to a one-stage repair has become well established, and the optimal technique for aortic repair seems to be partial direct anastomosis with patch augmentation. Left ventricular outflow tract obstruction (LVOTO) continues to be an important factor affecting survival and re-intervention rates after IAA repair. Great variability exists with regard to definition and diagnosis of LVOTO. To guide the decision for left ventricular outflow tract (LVOT) intervention and which type to use, we propose a simple formula based on the baby's weight. We advocate a conservative approach when the LVOT diameter is greater than the baby's weight + 2 mm and a LVOT bypass procedure (Yasui or Norwood) if the LVOT diameter is less than the baby's weight in millimeters. If the LVOT diameter falls in between, no definitive recommendation can be made, and the surgical approach is based on the surgeon's experience and overall philosophy.
主动脉弓中断（IAA）被定义为升主动脉和降主动脉之间管腔连续性的丧失。它与多种病变相关，从单纯的室间隔缺损到复杂病变。尽管在现代，治疗结果有所改善，但IAA修复仍伴随着显著的死亡率和发病率。近年来，一期修复已成为常规方法，而主动脉修复的最佳技术似乎是带补片扩大的部分直接吻合术。左心室流出道梗阻（LVOTO）仍然是影响IAA修复后生存率和再次干预率的重要因素。LVOTO的定义和诊断存在很大差异。为指导左心室流出道（LVOT）干预的决策以及使用何种类型的干预，我们提出了一个基于婴儿体重的简单公式。当LVOT直径大于婴儿体重 + 2毫米时，我们主张采取保守方法；如果LVOT直径小于以毫米为单位的婴儿体重，则采用LVOT旁路手术（安井手术或诺伍德手术）。如果LVOT直径介于两者之间，则无法给出明确建议，手术方法基于外科医生的经验和总体理念。
