Jang Woo Sung, Kim Woong-Han, Cho Sungkyu
Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Ann Thorac Surg. 2017 Mar;103(3):862-868. doi: 10.1016/j.athoracsur.2016.08.002. Epub 2016 Oct 15.
Left pulmonary artery (LPA) stenosis with acute angulation is a common cause of reoperation after tetralogy of Fallot repair. We therefore investigated surgical outcomes of acute-angle correction angioplasty.
Between 2005 and 2012, 53 patients underwent operation for LPA stenosis as a concurrent procedure. We divided the patients into two groups according to the LPA ostium angulation: group I (acute angle, acute-angle correction angioplasty, n = 29) and group II (obtuse angle, conventional patch angioplasty, n = 24), encompassing subgroup type I (focal stenosis) and type II (diffuse stenosis). The changes in the z score of LPA and lung perfusion rates were monitored using computed tomography and lung perfusion scans.
The z scores of LPA ostium and hilum were improved at 4.9 mean years of follow-up in group I (p = 0.002, p = 0.041). At the most recent follow-up, there were no differences in the LPA z score (p = 0.177; n = 16 in group I; n = 13 in group II) or left lung perfusion rates (group I: 39.5% ± 9.6%, n = 26; group II: 36.8% ± 11.2%, n = 18, p = 0.418) between the two groups. In group I, the ostial z scores and lung perfusion rates in patients with type II (-4.1 ± 3.1, 25.4%) were lower than patients with type I (-1.6 ± 2.5, 41.0%) at the most recent follow-up (p = 0.069, p = 0.001, respectively). The reoperation or reintervention rate was higher in patients with type II than in patients with type I in group I (p = 0.022).
Acute-angle correction angioplasty was associated with similar LPA ostium z scores and left lung perfusion rates in the two groups. Diffuse LPA stenosis compromised left lung perfusion and increased reoperation or reintervention rate.
伴有急性成角的左肺动脉（LPA）狭窄是法洛四联症修复术后再次手术的常见原因。因此，我们研究了急性角矫正血管成形术的手术效果。
2005年至2012年期间，53例患者接受了LPA狭窄同期手术。我们根据LPA开口角度将患者分为两组：I组（急性角，急性角矫正血管成形术，n = 29）和II组（钝角，传统补片血管成形术，n = 24），包括I型（局灶性狭窄）和II型（弥漫性狭窄）亚组。使用计算机断层扫描和肺灌注扫描监测LPA的z评分和肺灌注率的变化。
I组在平均4.9年的随访中，LPA开口和肺门的z评分得到改善（p = 0.002，p = 0.041）。在最近一次随访时，两组之间的LPA z评分（p = 0.177；I组n = 16；II组n = 13）或左肺灌注率（I组：39.5%±9.6%，n = 26；II组：36.8%±11.2%，n = 18，p = 0.418）无差异。在I组中，最近一次随访时，II型患者（-4.1±3.1，25.4%）的开口z评分和肺灌注率低于I型患者（-1.6±2.5，41.0%）（分别为p = 0.069，p = 0.001）。I组中II型患者的再次手术或再次干预率高于I型患者（p = 0.022）。
急性角矫正血管成形术使两组的LPA开口z评分和左肺灌注率相似。弥漫性LPA狭窄损害左肺灌注并增加再次手术或再次干预率。
