Talwar Sachin, Siddharth Bharat, Gupta Saurabh Kumar, Choudhary Shiv Kumar, Kothari Shyam Sunder, Juneja Rajnish, Saxena Anita, Airan Balram
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Interact Cardiovasc Thorac Surg. 2017 Nov 1;25(5):740-744. doi: 10.1093/icvts/ivx158.
To study the anatomic and haemodynamic data and results of surgery in patients undergoing surgical repair of aortopulmonary window beyond infancy.
Between July 2005 and December 2015, 23 patients, older than 1 year undergoing surgery for aortopulmonary window were analysed retrospectively. Postoperative clinical and echocardiography follow-up were performed.
Median age and weight at repair was 4 years (range 14 months-12 years) and 12 kg (range 3.5-22 kg), respectively. Fifteen patients had Richardson's Type I, 6 patients had Type II and 2 patients had Type III aortopulmonary window. Six patients had associated defects. Baseline mean systolic pulmonary artery pressure was 101 ± 14.9 mmHg (range 80-130, median 100 mmHg) and pulmonary vascular resistance index was 9.6 ± 5.9 (median 7.7 Wood units/m2, range 3.7-23.5 Wood units/m2). Patch repair of aortopulmonary window was performed using the sandwich method (transwindow) (n = 15), transaortic (n = 3) and transpulmonary artery (n = 2) approaches; 2 patients underwent double ligation and 1 underwent division and suturing. Two patients underwent valved patch closure of aortopulmonary window and 1 patient underwent valved patch closure of associated ventricular septal defect. There were 2 in-hospital deaths: one due to intractable pulmonary hypertension and the other due to low cardiac output. Mean follow-up was 36 months (range 2-119 months). Eighteen patients were in NYHA Class I at last follow-up. There were no late deaths or reoperation.
Surgery can be safely undertaken beyond infancy in carefully selected patients of aortopulmonary window with acceptable early and mid-term outcomes.
研究婴儿期后接受主肺动脉窗手术修复患者的解剖学和血流动力学数据以及手术结果。
回顾性分析2005年7月至2015年12月期间23例年龄超过1岁接受主肺动脉窗手术的患者。进行术后临床和超声心动图随访。
修复时的中位年龄和体重分别为4岁（范围14个月至12岁）和12千克（范围3.5至22千克）。15例患者为理查森I型，6例为II型，2例为III型主肺动脉窗。6例患者有相关缺陷。基线平均收缩期肺动脉压为101±14.9毫米汞柱（范围80至130，中位数100毫米汞柱），肺血管阻力指数为9.6±5.9（中位数7.7伍德单位/平方米，范围3.7至23.5伍德单位/平方米）。采用三明治法（经窗）（n = 15）、经主动脉（n = 3）和经肺动脉（n = 2）方法进行主肺动脉窗补片修复；2例患者进行双重结扎，1例进行分隔和缝合。2例患者进行了带瓣补片关闭主肺动脉窗，1例患者进行了带瓣补片关闭相关室间隔缺损。有2例住院死亡：1例死于顽固性肺动脉高压，另1例死于低心输出量。平均随访36个月（范围2至119个月）。最后一次随访时18例患者为纽约心脏协会I级。无晚期死亡或再次手术。
对于精心挑选的主肺动脉窗患者，婴儿期后可安全进行手术，早期和中期结果可接受。
