Cholette Jill M, Rubenstein Jeffrey S, Alfieris George M, McDermott Michael P, Harmon William G, Vermilion Roger, Eaton Michael P, Gangemi James J, Lerner Norma B
Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA.
Ann Thorac Surg. 2007 Oct;84(4):1320-5. doi: 10.1016/j.athoracsur.2007.05.026.
Thrombotic events cause significant morbidity and mortality in children who undergo surgery for complex congenital cardiac disease. We prospectively evaluated the incidence of thrombosis and examined preoperative and postoperative laboratory tests of coagulation and inflammation in neonates experiencing initial surgical palliation for variations of single ventricle physiology.
Neonates (<30 days) requiring initial surgical palliation were studied. All subjects received aspirin from postoperative day 1 onward. Thromboses were diagnosed by serial transthoracic echocardiograms, vascular imaging, and interstage cardiac catheterizations according to predefined criteria.
Twenty-two neonates, age 1 to 11 days (mean 4 +/- 2.5) were studied. Follow-up ranged from three hours to 18 months (median, 212 days). Eight infants died. Four of the 14 subjects who survived (28%), and one of the eight who died (12.5%), had evidence of thrombosis identified over a range of four hours to nine months postoperatively (median 14 days). When compared with reference values established in healthy children, preoperative subject hematocrit (Hct), platelet count, factors II, V, VII, VIII, and X, antithrombin, protein C, and soluble CD40 ligand measures were significantly lower, and the prothrombin time and partial thromboplastin time were significantly higher. Postoperative C reactive protein (CRP) was significantly higher, and Hct and platelet count significantly lower, than preoperative values. Thrombotic events were significantly related to high preoperative CRP (p = 0.02).
Thrombotic complications occur frequently in neonates undergoing initial palliative surgery, suggesting that aspirin therapy alone may constitute inadequate protection. Elevated preoperative CRP appears to be associated with increased thrombotic risk.
血栓形成事件在接受复杂先天性心脏病手术的儿童中会导致显著的发病率和死亡率。我们前瞻性地评估了血栓形成的发生率，并检查了接受单心室生理变异初次手术姑息治疗的新生儿术前和术后的凝血及炎症实验室检查。
对需要初次手术姑息治疗的新生儿（<30天）进行研究。所有受试者从术后第1天起接受阿司匹林治疗。根据预定义标准，通过系列经胸超声心动图、血管成像和分期心脏导管检查诊断血栓形成。
研究了22例年龄为1至11天（平均4±2.5）的新生儿。随访时间从3小时至18个月（中位数为212天）。8例婴儿死亡。14例存活受试者中有4例（28%），8例死亡受试者中有1例（12.5%）在术后4小时至9个月（中位数14天）范围内有血栓形成证据。与健康儿童确立的参考值相比，术前受试者的血细胞比容（Hct）、血小板计数、凝血因子II、V、VII、VIII和X、抗凝血酶、蛋白C和可溶性CD40配体测量值显著较低，而凝血酶原时间和部分凝血活酶时间显著较高。术后C反应蛋白（CRP）显著高于术前值，Hct和血小板计数显著低于术前值。血栓形成事件与术前高CRP显著相关（p = 0.02）。
接受初次姑息手术的新生儿频繁发生血栓形成并发症，提示仅阿司匹林治疗可能不足以提供充分保护。术前CRP升高似乎与血栓形成风险增加有关。
