Holzer Ralf J, Sisk Matt, Chisolm Joanne L, Hill Sharon L, Olshove Vincent, Phillips Alistair, Cheatham John P, Galantowicz Mark
Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA.
Pediatr Cardiol. 2009 Nov;30(8):1075-82. doi: 10.1007/s00246-009-9500-8. Epub 2009 Jul 23.
Residual structural pathology after cardiac surgery for congenital heart disease may complicate postoperative recovery. Completion angiograms obtained in the operating room may facilitate early detection and therapy of residual structural abnormalities. Our objective here is to report our institutional experience performing completion angiograms after cardiopulmonary bypass surgery. Between October 2007 and August 2008, 31 patients underwent completion angiograms after 32 cardiac surgical procedures. The median age was 7.5 months (range, 50 days to 31.2 years) and the median weight was 6.5 kg (range, 3.1-153 kg). Type of procedure, angiographic findings, and therapeutic decision were retrospectively reviewed. Procedures (proc) evaluated through completion angiography included comprehensive stage II or Glenn (n = 13), aortic arch reconstruction/conduit (n = 3), repair/palliation of tetralogy of Fallot or pulmonary atresia with ventricular septal defect (n = 4), PVR or conduit replacement (n = 5), and others (n = 7). Unexpected pathology was identified in 18 of 32 (56.3%) proc, which included left pulmonary artery (LPA) stenoses (n = 15), right pulmonary artery (RPA) stenoses (n = 11), and stenosis impairing coronary blood flow (after DKS; n = 1). In 9 of 32 (28.1%) proc, findings may have led to a change in therapeutic management. This included surgical revision (n = 1), 'Hybrid' therapy in the same setting (n = 2: LPA stent, 1; RPA balloon, 1), early catheterization within 3 months (n = 4), and change in medical management (n = 2: change in anticoagulation, 1; early CT, 1). Complications related to completion angiography were seen in only a single procedure (LPA staining). In conclusion, completion angiograms using a dedicated Hybrid cardiac operating suite may aid in early diagnosis and therapy of postsurgical abnormalities. They complement other methods of intraoperative imaging and may reduce the potential need for early surgical or transcatheter reintervention.
先天性心脏病心脏手术后残留的结构病理学改变可能会使术后恢复复杂化。在手术室进行的补充血管造影可能有助于早期发现和治疗残留的结构异常。我们在此的目的是报告我们机构在体外循环心脏手术后进行补充血管造影的经验。2007年10月至2008年8月期间，32例心脏手术患者中的31例接受了补充血管造影。中位年龄为7.5个月（范围50天至31.2岁），中位体重为6.5千克（范围3.1 - 153千克）。对手术类型、血管造影结果和治疗决策进行了回顾性分析。通过补充血管造影评估的手术包括综合二期手术或格林手术（n = 13）、主动脉弓重建/管道植入（n = 3）、法洛四联症或室间隔缺损合并肺动脉闭锁的修复/姑息治疗（n = 4）、肺血管阻力降低或管道置换（n = 5）以及其他手术（n = 7）。32例手术中有18例（56.3%）发现意外病变，其中包括左肺动脉（LPA）狭窄（n = 15）、右肺动脉（RPA）狭窄（n = 11）以及影响冠状动脉血流的狭窄（DKS术后；n = 1）。32例手术中有9例（28.1%）的检查结果可能导致了治疗方案的改变。这包括手术修正（n = 1）、同期“杂交”治疗（n = 2：LPA支架植入1例；RPA球囊扩张1例）、3个月内早期导管介入（n = 4）以及药物治疗调整（n = 2：抗凝调整1例；早期CT检查1例）。仅在1例手术（LPA染色）中出现了与补充血管造影相关的并发症。总之，使用专用杂交心脏手术室进行补充血管造影可能有助于早期诊断和治疗术后异常。它们补充了其他术中成像方法，并可能减少早期手术或经导管再次干预的潜在需求。
