Han Ra K, Gurofsky Rebecca C, Lee Kyong-Jin, Dipchand Anne I, Williams William G, Smallhorn Jeffrey F, McCrindle Brian W
Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.
J Am Coll Cardiol. 2007 Dec 18;50(25):2406-14. doi: 10.1016/j.jacc.2007.07.082.
The purpose of this study was to determine trends of growth of left heart structures after intervention for neonatal aortic valve stenosis.
The growth potential of left heart structures in neonatal aortic valve stenosis after relief of obstruction might influence risk for subsequent outcomes.
From 1994 to 2004, 53 patients underwent neonatal (< or =30 days old) balloon aortic valve dilation. Factors associated with time-related outcomes (death, reintervention, aortic valve replacement) and longitudinal changes in normalized left heart dimensions were sought.
The median age at intervention was 3.5 days (range 1 to 30 days). During a median follow-up of 3.2 years ranging up to 10.9 years, there were 31 reinterventions on the aortic valve in 21 (40%) patients and 7 deaths (13%). The presence of moderate or severe left ventricular (LV) endocardial fibroelastosis was the only independent predictor for time-related mortality (hazard ratio 22.1; p = 0.004), and a smaller initial aortic valve annulus z-score was a significant independent predictor for aortic valve replacement (hazard ratio 0.63 per 1-U change; p = 0.007). Aortic valve annulus, aortic sinus, and LV dimension z-scores significantly increased over time, whereas mitral valve z-scores remained below normal. The structure's initial z-score and concomitant size of other left heart structures were significant independent factors associated with subsequent z-scores.
There is potential catch-up growth of the aortic valve and LV over time for neonates after intervention for aortic valve stenosis. However, the continued hypoplasia of the mitral valve warrants further consideration in the long-term management of these patients.
本研究旨在确定新生儿主动脉瓣狭窄干预后左心结构的生长趋势。
新生儿主动脉瓣狭窄梗阻解除后左心结构的生长潜力可能影响后续结局的风险。
1994年至2004年，53例患者接受了新生儿（≤30日龄）球囊主动脉瓣扩张术。研究了与时间相关结局（死亡、再次干预、主动脉瓣置换）以及左心标准化尺寸纵向变化相关的因素。
干预时的中位年龄为3.5天（范围1至30天）。在中位随访3.2年（最长10.9年）期间，21例（40%）患者的主动脉瓣进行了31次再次干预，7例死亡（13%）。中度或重度左心室心内膜弹力纤维增生症的存在是与时间相关死亡率的唯一独立预测因素（风险比22.1；p = 0.004），初始主动脉瓣环z值较小是主动脉瓣置换的显著独立预测因素（每变化1个单位风险比0.63；p = 0.007）。主动脉瓣环、主动脉窦和左心室尺寸z值随时间显著增加，而二尖瓣z值仍低于正常水平。结构的初始z值和其他左心结构的伴随大小是与后续z值相关的显著独立因素。
新生儿主动脉瓣狭窄干预后，主动脉瓣和左心室随时间有潜在的追赶性生长。然而，二尖瓣持续发育不全在这些患者的长期管理中值得进一步考虑。
