Becker A E, Essed C E
Department of Pathology, University of Amsterdam, The Netherlands.
Am J Cardiovasc Pathol. 1988;1(3):301-17.
The pathology of the heart following surgical correction for congenital cardiac defects has not been fully explored. This study is based on valvar aortic stenosis, atrioventricular septal defect, complete transposition of the great arteries, and Fallot's tetralogy. Emphasis has been put on preexistent gross pathology, with histological verification, and postoperative complications. Among patients with aortic valve stenosis preexistent anomalies dominated (left ventricular hypoplasia, mitral valve abnormalities, left ventricular endocardial fibroelastosis). The findings suggest that the cases represent an extreme within a spectrum and could explain the late postoperative dismal results in patients suffering from congenital left heart obstruction. In patients with atrioventricular septal defects the important pathology related predominantly to the operative procedure (injury to the atrioventricular bundle, patch dehiscence at the site of the atrioventricular node, inadequate repair of the left atrioventricular valve leaflets) and to pulmonary obstructive vascular disease. In complete transposition of the great arteries, with or without ventricular septal defects, technical problems dominated. Obstruction of the systemic and pulmonic venous pathways, atrial dysrhythmia, and tricuspid valve injury were the most serious complications following Mustard's procedure. The Rastelli-type procedure was complicated by degeneration and calcification of the porcine valve and crowding of the left ventricle. The arterial switch was complicated by abnormal origin and course of the left circumflex artery, which led to kinking and myocardial infarction. In Fallot's tetralogy surgical complications (injury to the atrioventricular bundle and the tricuspid valve) were the most important. The study discloses that the heart after surgery for congenital heart disease cannot be considered without taking preexistent pathology into account. Careful preoperative investigations are mandatory, since most anomalies could have been detected and, hence, might have changed the operative result.
先天性心脏缺陷手术矫正后的心脏病理学尚未得到充分研究。本研究基于瓣膜性主动脉狭窄、房室间隔缺损、大动脉完全转位和法洛四联症展开。重点关注术前大体病理学情况，并进行组织学验证以及术后并发症研究。在主动脉瓣狭窄患者中，术前存在的异常情况占主导（左心室发育不全、二尖瓣异常、左心室内膜纤维弹性组织增生）。研究结果表明，这些病例代表了一个范围内的极端情况，这可以解释先天性左心梗阻患者术后不佳的远期结果。在房室间隔缺损患者中，重要的病理学情况主要与手术操作（房室束损伤、房室结部位补片裂开、左房室瓣叶修复不充分）以及肺阻塞性血管疾病有关。在大动脉完全转位患者中，无论有无室间隔缺损，技术问题占主导。体循环和肺静脉通路梗阻、房性心律失常以及三尖瓣损伤是Mustard手术最严重的并发症。Rastelli术式的并发症是猪瓣膜退变和钙化以及左心室拥挤。动脉调转术的并发症是左旋支动脉起源和走行异常，导致扭结和心肌梗死。在法洛四联症患者中，手术并发症（房室束和三尖瓣损伤）最为重要。该研究表明，考虑先天性心脏病手术后的心脏情况时不能不考虑术前存在的病理学情况。必须进行仔细的术前检查，因为大多数异常情况本可以被检测到，从而可能改变手术结果。
