Canter C E, Sekarski D C, Martin T C, Guitierrez F R, Spray T L
Edward Mallinckrodt Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, Missouri.
Ann Thorac Surg. 1989 Oct;48(4):544-50. doi: 10.1016/s0003-4975(10)66859-2.
Despite improving survival rates after repair of atrioventricular septal defect, many patients require reoperation because of postoperative heart failure. We used intraoperative color flow mapping echocardiography to assess the results of surgical repair of atrioventricular septal defect in 19 consecutive patients and compared those findings with results three to five days and 3 to 11 months after repair. There was close correlation between intraoperative and postoperative color flow mapping echocardiography in estimating the presence and severity of left atrioventricular valve regurgitation. All patients survived surgical repair, but in 4 (21%), postoperative congestive heart failure due to left atrioventricular valve regurgitation developed. The need for reoperation was significantly correlated with the severity of left atrioventricular valve regurgitation (r = 0.68) as estimated by intraoperative echocardiography and preoperative aberrancies in the atrioventricular valve (r = 0.68). Age, weight, additional congenital heart disease, preoperative pulmonary vascular resistance, preoperative atrioventricular valve regurgitation, and postoperative mean pulmonary arterial or left atrial pressure were not significantly correlated with the need for reoperation. Intraoperative color flow mapping echocardiography can accurately predict the development of early postoperative heart failure and subsequent reoperation after surgical repair of atrioventricular septal defect.
尽管房室间隔缺损修复术后生存率有所提高，但许多患者因术后心力衰竭仍需再次手术。我们使用术中彩色血流图超声心动图评估了19例连续患者的房室间隔缺损手术修复结果，并将这些结果与修复后3至5天及3至11个月的结果进行了比较。术中与术后彩色血流图超声心动图在评估左房室瓣反流的存在和严重程度方面具有密切相关性。所有患者均存活至手术修复，但4例（21%）因左房室瓣反流出现术后充血性心力衰竭。再次手术的需求与术中超声心动图评估的左房室瓣反流严重程度（r = 0.68）以及房室瓣术前异常（r = 0.68）显著相关。年龄、体重、额外的先天性心脏病、术前肺血管阻力、术前房室瓣反流以及术后平均肺动脉或左心房压力与再次手术的需求无显著相关性。术中彩色血流图超声心动图可准确预测房室间隔缺损手术修复后早期术后心力衰竭的发生及随后的再次手术。
