Chowdhury Ujjwal K, Avneesh Sheil, Ray Ruma, Reddy Srikrishna M, Kalaivani Mani, Hasija Suruchi, Kumari Lakshmi
Cardiothoracic Surgery, All India Institute of Medical Sciences, New Delhi, India.
Cardiothoracic Surgery, All India Institute of Medical Sciences, New Delhi, India.
Heart Lung Circ. 2018 Aug;27(8):1004-1010. doi: 10.1016/j.hlc.2017.08.011. Epub 2017 Sep 6.
The purposes of this study were to prospectively evaluate the histologic characteristics of the aortic wall of patients undergoing univentricular type of repair and compare the same with the findings observed in patients undergoing intracardiac repair of tetralogy of Fallot (TOF).
Operatively excised full-thickness aortic wall tissue from 99 consecutive patients undergoing either intracardiac repair of TOF (group I; n=42) or univentricular repair (group II; n=57) were studied by light microscopy. Age at operation was 13 months to 28 years (mean 99.97±73.21months) for group I and 9 months to 25 years (mean 79.52±60.09) months for group II patients.
Dilatation of the ascending aorta was present in 85.7% patients with TOF and 91.2% patients with a univentricular heart. Seventeen (17.2%) aortic specimens were histologically normal and were used as normal controls (group I, n=5; group II, n=12). A lamellar count of less than 60 was associated with a sensitivity of 97.2% and a specificity of 66.7% in patients undergoing repair of TOF and a sensitivity of 84.6% and a specificity of 80% in patients undergoing univentricular type of repairs respectively. Patients undergoing intracardiac repair of TOF and those undergoing univentricular repair exhibited 23.67 times (15.91-147.40) and 8.48 times (3.62-15.84) increased risk of aortic dilatation respectively.
Our findings indicate the existence of significant elastic fragmentation, muscle disarray, medionecrosis and fibrosis involving the ascending aortic media in patients with a functionally univentricular heart and dilated aorta. These histopathological changes are similar to those encountered in patients with TOF and dilated aorta.
本研究的目的是前瞻性评估接受单心室修复术患者的主动脉壁组织学特征，并与法洛四联症（TOF）心内修复术患者的观察结果进行比较。
对99例连续接受TOF心内修复术（I组；n = 42）或单心室修复术（II组；n = 57）的患者手术切除的全层主动脉壁组织进行光学显微镜检查。I组患者手术年龄为13个月至28岁（平均99.97±73.21个月），II组患者为9个月至25岁（平均79.52±60.09个月）。
85.7%的TOF患者和91.2%的单心室心脏患者存在升主动脉扩张。17份（17.2%）主动脉标本组织学正常，用作正常对照（I组，n = 5；II组，n = 12）。在接受TOF修复术的患者中，弹力层计数少于60与敏感性97.2%和特异性66.7%相关，在接受单心室修复术的患者中，敏感性为84.6%，特异性为80%。接受TOF心内修复术的患者和接受单心室修复术的患者主动脉扩张风险分别增加23.67倍（15.91 - 147.40）和8.48倍（3.62 - 15.84）。
我们的研究结果表明，功能单心室心脏和主动脉扩张患者的升主动脉中层存在明显的弹性纤维断裂、肌肉排列紊乱、中层坏死和纤维化。这些组织病理学变化与TOF和主动脉扩张患者中观察到的变化相似。
