Chang Yun Hee, Sung Si Chan, Lee Hyoung Doo, Ban Ji Eun, Choo Ki Seok, Lee Young Seok
Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, 1-10 Ami-dong, Seo-gu, Busan 602-739, South Korea.
Eur J Cardiothorac Surg. 2007 Jul;32(1):149-55. doi: 10.1016/j.ejcts.2007.03.027. Epub 2007 Apr 20.
Patch closure of the subarterial ventricular septal defect requires suture placement at the pulmonary annulus. We aimed to identify whether patch closure of subarterial ventricular septal defect would affect the growth of pulmonary annulus in comparison with that of perimembranous ventricular septal defect.
Of 361 patients who underwent patch closure of ventricular septal defect from January 1992 to December 1999, 98 (51 subarterial, 47 perimembranous) had echocardiographic data available for measurement of both preoperative and postoperative (more than 5 years after operation) pulmonary and aortic annular diameters. The pulmonary/aortic annular diameter ratio and their growth rates in the subarterial group were compared with those in the perimembranous group. The perioperative variables correlated with the pulmonary annular growth in subarterial group were also identified.
The mean follow-up duration was 7.2 years. Preoperative pulmonary/aortic annular diameter ratio was 1.45 (range, 0.94-2.31) in the subarterial group and 1.57 (range, 1.15-2.51) in the perimembranous group (p=0.059). The latest postoperative ratio was significantly lower in the subarterial group [subarterial: 1.02 (range, 0.77-1.41) vs perimembranous: 1.36 (range, 1.11-1.75), p<0.01]. Twenty-three patients (45%) in the subarterial group had the ratio less than 1. The pulmonary annular growth rate in the subarterial group was lower than that in the perimembranous group (subarterial: 0.34 mm/year, perimembranous: 1.03 mm/year, p<0.01). Preoperative pulmonary/aortic annular diameter ratio (r=0.885, p<0.01), age at operation (r=-0417, p<0.01), weight at operation (r=-0.357, p<0.05), and ventricular septal defect size (r=0.298, p<0.05) were found to have correlation with pulmonary annular growth in the subarterial group.
Our data show that pulmonary annular growth after patch repair of subarterial ventricular septal defect is suboptimal compared with perimembranous ventricular septal defect. Careful attention must be paid to the possible late clinical implication caused by impaired pulmonary annular growth after patch repair of subarterial ventricular septal defect.
动脉下室间隔缺损的补片修补需要在肺动脉瓣环处放置缝线。我们旨在确定动脉下室间隔缺损的补片修补与膜周部室间隔缺损相比是否会影响肺动脉瓣环的生长。
在1992年1月至1999年12月接受室间隔缺损补片修补的361例患者中，98例（动脉下型51例，膜周部型47例）有超声心动图数据可用于测量术前和术后（术后5年以上）的肺动脉和主动脉瓣环直径。比较动脉下组和膜周部组的肺动脉/主动脉瓣环直径比值及其生长速率。还确定了动脉下组与肺动脉瓣环生长相关的围手术期变量。
平均随访时间为7.2年。动脉下组术前肺动脉/主动脉瓣环直径比值为1.45（范围0.94 - 2.31），膜周部组为1.57（范围1.15 - 2.51）（p = 0.059）。动脉下组术后最新比值显著更低[动脉下组：1.02（范围0.77 - 1.41）vs膜周部组：1.36（范围1.11 - 1.75），p < 0.01]。动脉下组23例患者（45%）比值小于1。动脉下组肺动脉瓣环生长速率低于膜周部组（动脉下组：0.34 mm/年，膜周部组：1.03 mm/年，p < 0.01）。发现动脉下组术前肺动脉/主动脉瓣环直径比值（r = 0.885，p < 0.01）、手术年龄（r = -0.417，p < 0.01）、手术体重（r = -0.357，p < 0.05）和室间隔缺损大小（r = 0.298，p < 0.05）与肺动脉瓣环生长相关。
我们的数据表明，与膜周部室间隔缺损相比，动脉下室间隔缺损补片修补术后肺动脉瓣环生长欠佳。必须密切关注动脉下室间隔缺损补片修补术后肺动脉瓣环生长受损可能带来的晚期临床影响。
