Jijeh Abdulraouf, Ismail Muna, Alhabshan Fahad
1King Abdulaziz Cardiac Center,King Abdulaziz Medical City,Ministry of National Guard-Health Affairs,Riyadh,Kingdom of Saudi Arabia.
Cardiol Young. 2017 Sep;27(7):1323-1328. doi: 10.1017/S104795111700018X. Epub 2017 Mar 16.
Ventricular septal defect and aortic arch obstruction are usually associated with a narrow left ventricular outflow tract. The aim of the present study was to analyse the growth and predictors of future obstruction of the left ventricular outflow tract after surgical repair.
We carried out a retrospective review of patients who underwent repair for ventricular septal defect and aortic arch obstruction - coarctation or interrupted aortic arch - between July, 2002 and June, 2013. Echocardiographic data were reviewed, and the need for re-intervention was evaluated.
A total of 89 patients were included in this study. A significant left ventricular outflow tract growth was noticed after surgical repair. Preoperatively, the mean left ventricular outflow tract Z-score was -1.46±1 (range -5.5 to 1.1) and increased to a mean value of -0.7±1.3 (range -2.7 to 3.2) at last follow-up (p=0.0001), demonstrating relevant growth of the left ventricular outflow tract after repair for ventricular septal defect and aortic arch obstruction. After primary repair, 11 patients (12.3%) required re-intervention with surgical repair for left ventricular outflow tract obstruction after a mean period of 36±21 months. There were no significant differences in age, weight, and indexed aortic valve and left ventricular outflow tract measurements between those who developed obstruction and those who did not.
Significant left ventricular outflow tract growth is expected after repair of ventricular septal defect and aortic arch obstruction. Small aortic valve and left ventricular outflow tract at diagnosis are not risk factors to predict the need for surgical re-intervention for left ventricular outflow tract obstruction in future.
室间隔缺损和主动脉弓梗阻通常与左心室流出道狭窄有关。本研究的目的是分析手术修复后左心室流出道的生长情况及未来梗阻的预测因素。
我们对2002年7月至2013年6月期间接受室间隔缺损和主动脉弓梗阻（缩窄或主动脉弓中断）修复手术的患者进行了回顾性研究。回顾了超声心动图数据，并评估了再次干预的必要性。
本研究共纳入89例患者。手术修复后观察到左心室流出道有显著生长。术前，左心室流出道Z值的平均值为-1.46±1（范围为-5.5至1.1），在最后一次随访时增加到平均值-0.7±1.3（范围为-2.7至3.2）（p=0.0001），表明室间隔缺损和主动脉弓梗阻修复后左心室流出道有显著生长。初次修复后，11例患者（12.3%）在平均36±21个月后因左心室流出道梗阻需要再次进行手术修复。发生梗阻的患者与未发生梗阻的患者在年龄、体重、主动脉瓣指数和左心室流出道测量方面无显著差异。
室间隔缺损和主动脉弓梗阻修复后，预计左心室流出道会有显著生长。诊断时主动脉瓣和左心室流出道较小并非预测未来左心室流出道梗阻需要手术再次干预的危险因素。
