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动脉调转术后发生上瓣型肺动脉瓣狭窄的发病率降低。

Decreased incidence of supravalvar pulmonary stenosis after arterial switch operation.

机构信息

University of Rochester, Strong Memorial Hospital, Rochester, NY 14642, USA.

出版信息

Circulation. 2012 Sep 11;126(11 Suppl 1):S118-22. doi: 10.1161/CIRCULATIONAHA.111.082867.

Abstract

BACKGROUND

Supravalvar pulmonary stenosis (SVPS) is frequently observed after arterial switch. Traditionally the coronary arteries are removed from the neopulmonic root by excising the entire sinus of Valsalva. As a result, reconstruction of the neopulmonic root requires a pericardial patch encompassing two-thirds of the anastomosis between the neopulmonic root and pulmonary artery. We present a technique where the coronary arteries are removed as limited buttons of sinus tissue, leaving the transected edge of the neopulmonic root intact. We hypothesize that maintaining native arterial tissue in the anastomosis between the neopulmonic root and the pulmonary artery bifurcation reduces postoperative SVPS.

METHODS AND RESULTS

We performed a retrospective review of neonates with D-transposition of the great arteries undergoing arterial switch procedure from 1996 to 2009. Charts were reviewed, and clinical outcomes recorded for each patient. Most recent echocardiograms were evaluated for right ventricular outflow tract obstruction. A total of 120 patients received arterial switch using this technique. There was 99% survival and no injuries to the coronary arteries regardless of anatomy. Total follow-up was 564 patient-years. Mean follow-up at last clinical visit was 66 ± 46 months. Evaluation of the most recent outpatient echocardiogram revealed an average peak instantaneous gradient across the neopulmonic root of 22.5 ± 5 mm Hg. Only 7 (5%) patients required reintervention (balloon dilation, n=5; surgery, n=2).

CONCLUSIONS

Our technique of removing the coronary arteries as limited buttons, and anastomosis of the pulmonary artery using only native arterial tissue provides excellent midterm results with minimal SVPS.

摘要

背景

大动脉调转术后常发生瓣上型肺动脉狭窄(SVPS)。传统上,通过切除整个瓦氏窦来从新肺动脉根部移除冠状动脉。因此,新肺动脉根部的重建需要一个心包补片,覆盖新肺动脉根部和肺动脉吻合口的三分之二。我们介绍了一种技术,其中冠状动脉被作为有限的窦组织瓣移除,使新肺动脉根部的吻合口的横断缘保持完整。我们假设,在新肺动脉根部和肺动脉分叉之间的吻合口中保留天然动脉组织可以减少术后 SVPS。

方法和结果

我们对 1996 年至 2009 年间接受大动脉调转术的 D 型大动脉转位新生儿进行了回顾性研究。回顾了病历,并记录了每位患者的临床结果。对最近的超声心动图进行评估,以确定右心室流出道梗阻。共有 120 例患者采用这种技术接受了动脉调转术。手术成功率为 99%,且无论冠状动脉解剖结构如何,均未发生冠状动脉损伤。总随访时间为 564 患者年。最近一次临床就诊时的平均随访时间为 66±46 个月。最近一次门诊超声心动图评估显示,新肺动脉根部的平均峰值瞬时跨瓣梯度为 22.5±5mmHg。仅有 7 例(5%)患者需要再次介入治疗(球囊扩张,n=5;手术,n=2)。

结论

我们采用的移除冠状动脉作为有限瓣、仅使用天然动脉组织吻合肺动脉的技术,提供了出色的中期结果,SVPS 发生率极低。

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