Brink Johann, MacIver Robroy, Lee Melissa G Y, Konstantinov Igor E, Cheung Michael, Brizard Christian P, d'Udekem Yves
Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics of the University of Melbourne, Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
Ann Thorac Surg. 2015 Feb;99(2):641-7. doi: 10.1016/j.athoracsur.2014.09.034. Epub 2014 Dec 20.
Coarctation of the pulmonary artery may lead to its early obstruction. We investigated the outcomes of a strategy of aggressive reconstruction of the pulmonary arteries in the neonatal period.
From 2000 to 2013 a total of 162 consecutive neonates (< 90 days) underwent systemic-to-pulmonary shunting. Twenty-eight of them underwent the following concomitant reconstruction of the central pulmonary arteries: end-to-end anastomosis (4), patch reconstruction of the pulmonary arteries (24) with 0.4 mm Gore-Tex (W. L. Gore & Associates, Newark, DE) patch (18), or autologous pericardium (6). Ten patients were directed to univentricular palliation and 18 to biventricular repair.
There was 1 in-hospital death (4%) and 2 deaths after hospital discharge (inter-stage mortality, 7%). The follow-up of the 25 survivors was complete. After a mean of 3 ± 3 years, patients with single ventricle palliation reached the following stages: shunts (2); one and a half ventricle repair (1); bidirectional cavopulmonary shunt (4); and Fontan (2). Fourteen of the patients destined for biventricular physiology reached complete repair while 2 patients were still with shunts. There was no pulmonary artery occlusion. Focal narrowing or pulmonary artery hypoplasia was the main indication for 10 of the subsequent 36 reinterventions.
Neonatal pulmonary artery reconstruction effectively prevents pulmonary artery occlusion and warrants pulmonary artery growth in the majority of cases of juxtaductal pulmonary artery coarctation. A number of these patients needed enlargement of their central pulmonary arteries in subsequent procedures. Indications of this reconstruction at the time of systemic-to-pulmonary shunting remains to be specified.
肺动脉缩窄可能导致其早期梗阻。我们研究了新生儿期积极重建肺动脉策略的效果。
2000年至2013年，共有162例连续的新生儿（<90天）接受了体肺分流术。其中28例同时进行了中央肺动脉重建：端端吻合术（4例），用0.4毫米戈尔特斯（W.L.戈尔公司，纽瓦克，特拉华州）补片（18例）或自体心包（6例）进行肺动脉补片重建。10例患者接受了单心室姑息治疗，18例接受了双心室修复。
有1例住院死亡（4%），2例出院后死亡（阶段间死亡率，7%）。对25名幸存者进行了完整的随访。平均3±3年后，接受单心室姑息治疗的患者达到以下阶段：分流（2例）；一点五心室修复（1例）；双向腔肺分流（4例）；以及Fontan手术（2例）。预定进行双心室生理修复的14例患者实现了完全修复，2例患者仍有分流。没有肺动脉闭塞。局灶性狭窄或肺动脉发育不全是随后36次再次干预中10次的主要指征。
新生儿肺动脉重建有效地预防了肺动脉闭塞，在大多数动脉导管周围肺动脉缩窄病例中保证了肺动脉的生长。这些患者中有许多人在随后的手术中需要扩大中央肺动脉。在体肺分流时进行这种重建的指征仍有待明确。
