Chowdhury Ujjwal K, Mishra Anand K, Ray Ruma, Kalaivani Mani, Reddy Srikrishna M, Venugopal Panangipalli
Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, New Delhi, India.
J Thorac Cardiovasc Surg. 2008 Jan;135(1):69-77, 77.e1-11. doi: 10.1016/j.jtcvs.2007.06.011.
The purposes of this study were to evaluate the histologic characteristics of the aortic wall and the risk factors related to histopathology and aortic dilatation in patients undergoing intracardiac repair of tetralogy of Fallot.
Operatively excised full-thickness aortic wall tissue from 98 consecutive patients undergoing intracardiac repair of tetralogy of Fallot aged 6 months to 47 years (mean 104.5 +/- 102.8 months; median 72 months) were studied by light microscopy. The receiver operating characteristic curve analysis was done to quantify the diagnostic accuracy of loss of lamellar counts and multiple logistic regression models.
Twenty-five (25.5%) aortic tissue specimens were indicated as histologically normal and were used as normal controls. The incidence of elastic fragmentation, increased ground substance, medionecrosis, smooth muscle disarray, and fibrosis was 74.5%, 54%, 39.8%, 26.5%, and 57.1%, respectively. A lamellar count of less than 60 was associated with a sensitivity of 80% and a specificity of 87.67%. Area under the receiver operating characteristic curve indicated that 93.37% (standard error +/- 0.039) of the time the value of lamellar count was lower for the abnormal histopathology group than for the normal group (P < .001). The risk of aortic dilatation was 15.97 times higher in patients with histopathologically abnormal aorta.
The majority of aortic media of the ascending aorta in cyanotic tetralogy of Fallot indicates significant loss of lamellar units and pre-existing intrinsic aortopathy. The changes are present since infancy and are more pronounced in older patients subjected to long-standing cyanosis and volume overload and may account for or may coexist with the higher incidence of aortic dilatation encountered in these patients.
本研究旨在评估法洛四联症心内修复术后患者主动脉壁的组织学特征以及与组织病理学和主动脉扩张相关的危险因素。
对98例年龄在6个月至47岁（平均104.5±102.8个月；中位数72个月）接受法洛四联症心内修复术的连续患者手术切除的全层主动脉壁组织进行光镜检查。采用受试者工作特征曲线分析来量化板层计数减少和多元逻辑回归模型的诊断准确性。
25份（25.5%）主动脉组织标本组织学正常，用作正常对照。弹性纤维断裂、基质增加、中层坏死、平滑肌排列紊乱和纤维化的发生率分别为74.5%、54%、39.8%、26.5%和57.1%。板层计数少于60与80%的敏感性和87.67%的特异性相关。受试者工作特征曲线下面积表明，异常组织病理学组的板层计数值低于正常组的时间占93.37%（标准误±0.039）（P<0.001）。组织病理学主动脉异常的患者主动脉扩张风险高15.97倍。
青紫型法洛四联症升主动脉的大多数主动脉中膜显示板层单位显著丧失和先天性主动脉病变。这些变化自婴儿期就存在，在长期青紫和容量超负荷的老年患者中更明显，可能是这些患者主动脉扩张发生率较高的原因或与之共存。
