Egan Matthew J, Hill Sharon L, Boettner Bethany L, Holzer Ralf J, Phillips Alistair B, Galantowicz Mark, Cheatham John P, Kovalchin John P
The Heart Center, Nationwide Children's Hospital, The Ohio State University, 6th Floor Education Building, 700 Children's Drive, Columbus, OH 43205, USA.
Pediatr Cardiol. 2011 Jan;32(1):67-75. doi: 10.1007/s00246-010-9820-8. Epub 2010 Oct 19.
A potential complication after hybrid stage 1 palliation for hypoplastic left heart syndrome (HLHS) is retrograde aortic arch obstruction (RAAO). This can lead to increased morbidity and unplanned surgical or interventional procedures in the interstage period. This study aimed to identify potential predictors of RAAO by analyzing initial echocardiograms and angiograms before hybrid stage 1 palliation. For this study, 96 patients who underwent hybrid stage 1 palliation between July 2002 and July 2009 were reviewed, 68 of which had standard HLHS and met the inclusion criteria. The initial echocardiogram, hybrid stage 1 angiograms, and follow-up echocardiograms were reviewed. Anatomic and hemodynamic measurements were obtained by both modalities, and comparisons were made between those who developed RAAO and those who did not. Of the 68 patients, 20 (29%) had RAAO. The mean aortic root size was smaller for the patients who had RAAO (3.6 vs 4.4 mm; p = 0.036). The angiographic angle between the aortic isthmus and the patent ductus arteriosus (PDA) was significantly larger in the RAAO group (86° vs 63°; p = 0.008). The retrograde aortic arch velocities were higher in the RAAO group. Patients with RAAO have a smaller aortic root and higher retrograde velocities on initial echocardiogram. Patients with RAAO show a larger angle between the retrograde arch and PDA on angiogram. Because RAAO is an important potential complication after hybrid stage 1 palliation for HLHS, identification of predictors of RAAO may lead to improved care and outcome for patients with RAAO.
对于左心发育不全综合征（HLHS），一期杂交姑息治疗后的一个潜在并发症是逆行性主动脉弓梗阻（RAAO）。这可能导致在两期治疗间期发病率增加以及计划外的手术或介入治疗。本研究旨在通过分析一期杂交姑息治疗前的初始超声心动图和血管造影来确定RAAO的潜在预测因素。在本研究中，回顾了2002年7月至2009年7月期间接受一期杂交姑息治疗的96例患者，其中68例患有标准HLHS并符合纳入标准。对初始超声心动图、一期杂交血管造影和随访超声心动图进行了回顾。通过两种方式获得解剖学和血流动力学测量值，并对发生RAAO的患者和未发生RAAO的患者进行比较。在这68例患者中，20例（29%）发生了RAAO。发生RAAO的患者主动脉根部平均尺寸较小（3.6 vs 4.4 mm；p = 0.036）。RAAO组主动脉峡部与动脉导管未闭（PDA）之间的血管造影角度明显更大（86° vs 63°；p = 0.008）。RAAO组的逆行性主动脉弓速度更高。发生RAAO的患者在初始超声心动图上主动脉根部较小且逆行速度较高。发生RAAO的患者在血管造影上显示逆行弓与PDA之间的角度更大。由于RAAO是HLHS一期杂交姑息治疗后的一个重要潜在并发症，识别RAAO的预测因素可能会改善RAAO患者的治疗和预后。
