Cardis Brian M, Fyfe Derek A, Mahle William T
Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA.
Ann Thorac Surg. 2006 Mar;81(3):988-91. doi: 10.1016/j.athoracsur.2005.09.065.
Patients with repaired coarctation of the aorta retain abnormal elastic properties of the aorta. It is not known whether patients with hypoplastic left heart syndrome also manifest abnormal elastic properties after palliative surgery. The presence of such abnormalities may have important clinical implications as reduced aortic compliance might adversely impact single right ventricular function.
We prospectively evaluated the elastic properties of the aorta in a cohort of patients with hypoplastic left heart syndrome who had undergone the Norwood procedure with aortic arch reconstruction and subsequent bidirectional Glenn or Fontan procedure. The hypoplastic left heart syndrome patients (n = 20) were compared with single-ventricle patients (n = 18) without history of arch reconstruction and patients with double-ventricular lesions (n = 22). Aortic elastic function was quantified by distensibility index and stiffness index. M-mode measurements of the transverse aortic arch were obtained with transesophageal echocardiography under general anesthesia. Patients were evaluated at a median age of 22.2 months with no age difference between patient subgroups.
Distensibility index was significantly less (p = 0.007) and stiffness index greater (p = 0.005) in the reconstructed arch of hypoplastic left heart syndrome patients compared with single-ventricle and double-ventricle patients.
Patients with hypoplastic left heart syndrome after Norwood palliation have increased aortic stiffness and decreased distensibility in the reconstructed transverse arch. As previous studies in adults have shown that decreased aortic compliance increases the energy cost of cardiac ejection, examination of modifications to the surgical technique that might improve elastic properties is warranted.
主动脉缩窄修复术后的患者，其主动脉弹性特性仍异常。目前尚不清楚左心发育不全综合征患者在姑息性手术后是否也表现出异常的弹性特性。此类异常的存在可能具有重要的临床意义，因为主动脉顺应性降低可能会对单右心室功能产生不利影响。
我们前瞻性评估了一组接受诺伍德手术并进行主动脉弓重建，随后接受双向格林或Fontan手术的左心发育不全综合征患者的主动脉弹性特性。将左心发育不全综合征患者（n = 20）与无主动脉弓重建病史的单心室患者（n = 18）和双心室病变患者（n = 22）进行比较。通过扩张性指数和僵硬度指数对主动脉弹性功能进行量化。在全身麻醉下，经食管超声心动图获得主动脉弓横向的M型测量值。患者的中位年龄为22.2个月，各亚组患者之间无年龄差异。
与单心室和双心室患者相比，左心发育不全综合征患者重建弓的扩张性指数显著降低（p = 0.007），僵硬度指数更高（p = 0.005）。
诺伍德姑息治疗后的左心发育不全综合征患者，其重建的主动脉弓僵硬度增加，扩张性降低。正如先前在成人中的研究表明，主动脉顺应性降低会增加心脏射血的能量消耗，因此有必要研究可能改善弹性特性的手术技术改良方法。
