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Berry 综合征一期手术矫正的近期疗效。

Current outcomes of one-stage surgical correction for Berry syndrome.

机构信息

Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.

Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.

出版信息

J Thorac Cardiovasc Surg. 2017 May;153(5):1139-1147. doi: 10.1016/j.jtcvs.2016.11.058. Epub 2016 Dec 19.

Abstract

OBJECTIVES

Berry syndrome is a combination of distal aortopulmonary window (APW), aortic origin of the right pulmonary artery (RPA), intact ventricular septum, and interrupted aortic arch. We present here our current experience of primary repair of this syndrome with the goal of optimizing treatment for this rare condition.

METHODS

From January 2003 through December 2015, 16 infants with Berry syndrome underwent one-stage repair at Shanghai Children's Medical Center. Three different surgical correction techniques were used to repair the APW and aortic origin of the RPA, including intra-aortic baffle in 5, RPA detachment in 6, and RPA angioplasty with aortic cuff in 5 patients.

RESULTS

The median age at repair was 90.5 days (range, 8-170 days). The interrupted aortic arch morphology was type A in 14 and type B in 2 patients. The APW morphology was type IIa in 4, type IIb in 10, and type III in 2 patients. Hospital death occurred in 2 patients, and death at follow-up occurred in one other patient. Three patients who previously underwent RPA angioplasty with aortic cuff required reoperation for aortic or RPA stenosis. Freedom from reoperation was 84.8%, 75.4%, and 75.4%, respectively at 1, 5, and 10 years after surgery.

CONCLUSIONS

One-stage repair of Berry syndrome has achieved acceptable outcomes. Reoperations mainly are related to aortic or RPA stenosis, and the reoperation rate is higher when RPA arterioplasty is performed with an aortic cuff.

摘要

目的

Berry 综合征是一种由远端主肺动脉窗(APW)、起源于主动脉的右肺动脉(RPA)、完整的室间隔和主动脉弓中断组成的综合征。我们在此介绍我们目前对该综合征进行一期修复的经验,旨在优化这种罕见疾病的治疗。

方法

从 2003 年 1 月至 2015 年 12 月,上海儿童医学中心有 16 例 Berry 综合征婴儿接受了一期修复。使用了三种不同的手术矫正技术来修复 APW 和 RPA 的起源,包括 5 例主动脉内挡板、6 例 RPA 分离和 5 例 RPA 血管成形术伴主动脉袖口。

结果

修复时的中位年龄为 90.5 天(范围 8-170 天)。中断的主动脉弓形态学为 A 型 14 例,B 型 2 例。APW 形态学为 IIa 型 4 例,IIb 型 10 例,III 型 2 例。2 例患儿在住院期间死亡,1 例患儿在随访期间死亡。3 例先前接受过 RPA 血管成形术伴主动脉袖口的患者因主动脉或 RPA 狭窄而需要再次手术。术后 1、5 和 10 年,无再手术率分别为 84.8%、75.4%和 75.4%。

结论

Berry 综合征的一期修复已取得可接受的结果。再次手术主要与主动脉或 RPA 狭窄有关,当使用主动脉袖口进行 RPA 血管成形术时,再手术率较高。

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