Siehr Stephanie L, Maeda Katsuhide, Connolly Andrew A, Tacy Theresa A, Reddy V Mohan, Hanley Frank L, Perry Stanton B, Wright Gail E
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California.
Ann Thorac Surg. 2016 Jan;101(1):162-7. doi: 10.1016/j.athoracsur.2015.09.056. Epub 2015 Nov 18.
There are conflicting reports regarding the importance of mitral stenosis and aortic atresia as a risk factor for Norwood mortality. This study reviews outcomes of this anatomic subgroup at our institution and examines the utility of preoperative cardiac catheterization and its correlation with clinical outcomes and pathology findings.
This is a single-center, retrospective review of hypoplastic left heart syndrome patients who underwent modified Norwood operation between October 2005 and May 2013.
Fourteen of 74 hypoplastic left heart syndrome patients (19%) had mitral stenosis and aortic atresia. Operative mortality for MS/AA was 29% versus 7% for all other hypoplastic left heart syndrome anatomic subgroups (p = 0.04). Although only 19% of the entire cohort, the mitral stenosis and aortic atresia subgroup constituted 50% of the total operative mortality and the only interstage deaths. Autopsies support myocardial ischemia as the mechanism of death. Although preoperative angiography defined the presence of ventriculo-coronary connections, it did not clearly risk stratify patients in regard to operative mortality.
Mitral stenosis and aortic atresia is a risk factor for perioperative myocardial ischemia and mortality. Further exploration of myocardial reserve is warranted.
关于二尖瓣狭窄和主动脉闭锁作为诺伍德手术死亡率风险因素的重要性，存在相互矛盾的报道。本研究回顾了我院该解剖亚组的治疗结果，并探讨了术前心导管检查的效用及其与临床结果和病理发现的相关性。
这是一项对2005年10月至2013年5月期间接受改良诺伍德手术的左心发育不全综合征患者的单中心回顾性研究。
74例左心发育不全综合征患者中有14例（19%）存在二尖瓣狭窄和主动脉闭锁。二尖瓣狭窄/主动脉闭锁患者的手术死亡率为29%，而所有其他左心发育不全综合征解剖亚组的手术死亡率为7%（p = 0.04）。二尖瓣狭窄和主动脉闭锁亚组虽然仅占整个队列的19%，但却占总手术死亡率的50%，且是仅有的过渡期死亡病例。尸检支持心肌缺血为死亡机制。尽管术前血管造影确定了心室-冠状动脉连接的存在，但它并未明确对患者的手术死亡率进行风险分层。
二尖瓣狭窄和主动脉闭锁是围手术期心肌缺血和死亡的风险因素。有必要进一步探索心肌储备情况。
