The Division of Cardiothoracic Surgery, National Medical Center for Children and Mothers, 2-10-1, Okura, Setagaya-ku, Tokyo, Japan.
Ann Thorac Surg. 2010 Aug;90(2):588-92. doi: 10.1016/j.athoracsur.2010.04.065.
The neonatal repair of interrupted aortic arch and ventricular septal defect (IAA/VSD) presents a surgical challenge. Although one-stage repair has become well established, left ventricular outflow tract obstruction (LVOTO) continues to be an important factor affecting survival and reintervention rates after IAA/VSD repair. We investigated the relationship between the preoperative aortic annulus and the rates of reoperation for LVOTO.
Between July 1994 and July 2006, 38 patients with IAA/VSD have undergone complete single-stage repair. Patients with single ventricle physiology, transposition of the great arteries, or truncus arteriosus were excluded. Surgical technique involved the aortic arch reconstruction and VSD closure. Three patients underwent subaortic resection at the time of first operation and one patient underwent Yasui operation. The patients were divided into two groups according to whether the aortic annulus is greater than the patient's weight (kg) + 1.5 mm or less.
The average follow-up was 7.9 +/- 4.2 years. Among the patients with small aortic annulus (n = 12), there was one hospital death and 6 reoperations for LVOTO, and one late death. There was only one reoperation for LVOTO among the patients with larger aortic annulus (n = 26, p < 0.001). The patients whose aortic annulus is less than patient's weight (kg) + 1.0 mm had poor outcomes if the LVOTO is not addressed at the time of the first operation.
Neonatal single-stage repair for IAA/VSD achieves excellent survival. For the patients whose aortic annulus is greater than patient's weight (kg) + 1.5 mm, low reoperation rate for LVOTO is expected. For the patient whose aortic annulus is less than patient's weight + 1.5 mm, almost half of them needed reoperation. An LVOT bypass procedure (Yasui or Norwood) is recommended if the aortic annulus is less than the patient's weight + 1.0 mm.
新生儿主动脉弓中断合并室间隔缺损（IAA/VSD）的修复具有挑战性。虽然一期修复已得到广泛应用，但左心室流出道梗阻（LVOTO）仍然是影响 IAA/VSD 修复后生存率和再干预率的重要因素。我们研究了主动脉瓣环与 LVOTO 再手术率之间的关系。
1994 年 7 月至 2006 年 7 月，38 例 IAA/VSD 患者接受了完全一期修复。排除单心室生理、大动脉转位或动脉干畸形患者。手术技术包括主动脉弓重建和室间隔缺损闭合。3 例患者在初次手术时行主动脉瓣下切除术，1 例患者行 Yasui 手术。根据主动脉瓣环直径是否大于患者体重（kg）+1.5mm 分为两组。
平均随访 7.9±4.2 年。主动脉瓣环较小（n=12）的患者中有 1 例院内死亡和 6 例 LVOTO 再手术，1 例晚期死亡。主动脉瓣环较大（n=26）的患者中仅 1 例发生 LVOTO 再手术（p<0.001）。如果初次手术时不解决 LVOTO，主动脉瓣环小于患者体重（kg）+1.0mm 的患者预后较差。
新生儿主动脉弓中断合并室间隔缺损的一期修复可获得良好的生存率。主动脉瓣环大于患者体重（kg）+1.5mm 的患者，LVOTO 再手术率低。主动脉瓣环小于患者体重+1.5mm 的患者，近一半需要再次手术。如果主动脉瓣环小于患者体重+1.0mm，建议行左心室流出道旁路术（Yasui 或 Norwood）。
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