Moller J H, Patton C, Varco R L, Lillehei C W
Department of Pediatrics, University of Minnesota, Minneapolis 55455.
Am J Cardiol. 1991 Dec 1;68(15):1491-7. doi: 10.1016/0002-9149(91)90284-r.
This study was designed to determine the clinical status, cause of death, and effects of pulmonary vascular disease and conduction abnormalities 30 to 35 years after surgery in 296 consecutive surviving patients of closure of ventricular septal defect. Of the 296 patients, current status was determined by contact with patient and physician in 290 cases, with 6 (2%) lost to follow-up (7,912 patient years are included). Cardiac catheterization after surgery in 168 patients showed complete closure of the defect in 80%. Death occurred in 59 patients (20%), with higher mortality rates in those operated on after the age of 5 years, those with pulmonary vascular resistance greater than 7 units (51%), and those with complete heart block (78%). Of 37 patients with transient heart block after surgery, 8 (22%) have died (3 pulmonary vascular disease, 2 sudden death, 2 unknown causes and 1 complete heart block). Twenty other patients had a dysarrhythmia after surgery, and none of these died. Nine episodes of endocarditis occurred (11.4/10,000 patient years). Nine of 296 (3%) offspring had cardiac malformation. Most patients are in New York Heart Association class I, 57% attended college and 15% received an advanced degree. The data show good results for this group of patients operated on during an early era (1954 to 1960) of open cardiac surgery. They support the current trend toward operation in patients with ventricular septal defects at an early age and with low pulmonary vascular resistance.
本研究旨在确定296例连续存活的室间隔缺损闭合术后30至35年患者的临床状况、死亡原因以及肺血管疾病和传导异常的影响。在这296例患者中，通过与患者及医生联系确定了290例患者的当前状况，6例（2%）失访（纳入7912患者年）。168例患者术后的心导管检查显示80%的缺损完全闭合。59例患者（20%）死亡，5岁以后接受手术的患者、肺血管阻力大于7单位的患者（51%）以及完全性心脏传导阻滞患者（78%）的死亡率更高。术后发生短暂性心脏传导阻滞的37例患者中，8例（22%）死亡（3例死于肺血管疾病，2例猝死，2例死因不明，1例死于完全性心脏传导阻滞）。另外20例患者术后发生心律失常，无一死亡。发生9次心内膜炎（11.4/10000患者年）。296例（3%）后代中有9例患有心脏畸形。大多数患者属于纽约心脏协会I级，57%上过大学，15%获得高等学位。数据表明，对于这组在心脏直视手术早期（1954年至1960年）接受手术的患者，结果良好。这些数据支持目前对于室间隔缺损患者在幼年且肺血管阻力较低时进行手术的趋势。
