室间隔缺损的自然主动脉瓣并发症：一项前瞻性队列研究。

Natural aortic valve complications of ventricular septal defect: a prospective cohort study.

作者信息

Layangool Thanarat, Kirawittaya Tawatchai, Sangtawesin Chaisit, Kojaranjit Vichow, Makarapong Perapat, Pechdamrongsakul Amornrat, Intasorn Yanisa, Noisang Putra

机构信息

Cardiology Unit, Queen Sirikit National Institute of Child Health, Department of Medical Services, College of Medicine, Rangsit University, Bangkok, Thailand.

出版信息

J Med Assoc Thai. 2008 Oct;91 Suppl 3:S53-9.

PMID:19255993

Abstract

OBJECTIVE

To study the incidence and onset of aortic valve prolapse (AVP) and aortic regurgitation (AR) in the ventricular septal defect (VSD).

STUDY DESIGN

A prospective cohort study

POPULATION

The less than one-year-old children with diagnosis of isolated VSD were studied from October 2000 to September 2006 at Queen Sirikit National Institute of Child Health. Clinical follow-up and echocardiographic studies were scheduled every 2-3 months in the first year of age and then every 6 months to evaluate the size, location, flow across VSD, aortic valve morphology and aortic regurgitation.

RESULTS

Three hundred and twenty-one cases of VSD were followed up. One was excluded due to associated hypoplastic RV An overall of 2,644 echocardiograms were performed. The percentage of perimembranous, subpulmonic, muscular inlet and multiple types were 70.3%, 19.4%, 5.6%, 3.1% and 1.6%, respectively. Size of the VSD was diagnosed to be small, moderate, and large VSD in 62.5%, 15.9% and 21.6% respectively. At the end of the study, the incidence of AVP in subpulmonic VSD was 87.1% compared to 16.4% in perimembranous VSD, with a relative risk of 5.30 and the incidence of AR in subpulmonic VSD was 37.1% compared to 5.3% in perimembranous VSD, with a relative risk of 6.95. From the survival analysis, the patient with subpulmonic VSD developed AVP at 46%, 77%, 90% and 94% compare to 8%, 13%, 20% and 23% of perimembranous VSD at 12, 24, 36 and 48 months of age respectively (p < 0.001). The patient with subpulmonic VSD developed AR at 8%, 17%, 35% and 38% compare to 2%, 4%, 5% and 7% of perimembranous VSD at 12, 24, 36 and 48 months of age respectively (p < 0.001). At the end of the study, ninety-six cases (30%) underwent cardiac operation with the indication of heart failure or the occurrence of AR. Sixty one cases (19.1%), including two cases of subpulmonic type had spontaneous closure of VSD. Seven cases (2.2%) had lost to follow up and five cases (1.6%) died during the follow up period.

CONCLUSION

The incidence of AVP and AR are high in subpulmonic VSD being much higher than perimembranous VSD with a relative risk of 5.30 and 6.95 respectively. These complications are significantly from infancy period and are an indication for early cardiac surgery.

摘要

目的

研究室间隔缺损（VSD）患者主动脉瓣脱垂（AVP）和主动脉瓣反流（AR）的发生率及发病情况。

研究设计

前瞻性队列研究

研究对象

2000年10月至2006年9月在诗丽吉王后国家儿童健康研究所对诊断为单纯性VSD的1岁以下儿童进行研究。在患儿1岁以内每2 - 3个月进行一次临床随访和超声心动图检查，之后每6个月进行一次，以评估VSD的大小、位置、跨VSD血流、主动脉瓣形态及主动脉瓣反流情况。

结果

对321例VSD患者进行了随访。1例因合并右心室发育不全被排除。共进行了2644次超声心动图检查。膜周部、肺动脉瓣下、肌部流入道及多发类型的比例分别为70.3%、19.4%、5.6%、3.1%和1.6%。VSD大小诊断为小、中、大VSD的分别占62.5%、15.9%和21.6%。研究结束时，肺动脉瓣下VSD的AVP发生率为87.1%，而膜周部VSD为16.4%，相对风险为5.30；肺动脉瓣下VSD的AR发生率为37.1%，而膜周部VSD为5.3%，相对风险为6.95。生存分析显示，肺动脉瓣下VSD患者在12、24、36和48个月时发生AVP的比例分别为46%、77%、90%和94%，而膜周部VSD分别为8%、13%、20%和23%（p < 0.001）。肺动脉瓣下VSD患者在12、24、36和48个月时发生AR的比例分别为8%、17%、35%和38%，而膜周部VSD分别为2%、4%、5%和7%（p < 0.001）。研究结束时，96例（30%）因心力衰竭或发生AR而接受心脏手术。61例（19.1%），包括2例肺动脉瓣下型VSD患者，VSD自发闭合。7例（2.2%）失访，5例（1.6%）在随访期间死亡。