Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, CA, USA.
Cleft Palate Craniofac J. 2020 Aug;57(8):957-966. doi: 10.1177/1055665620924915. Epub 2020 May 28.
To evaluate characteristics of congenital heart disease (CHD) in patients with cleft lip and/or palate (CL/P) and assess potential associations with cleft outcomes.
Retrospective review of all patients with CL/P who underwent primary cleft treatment from 2009 to 2015.
Children's Hospital Los Angeles, a tertiary hospital.
Exclusion criteria included microform cleft lip diagnosis, international patients, and patients presenting for secondary repair or revision after primary repair at another institution.
Patient demographics, prenatal and birth characteristics, CL/P characteristics, syndromic status, postoperative complications, and other outcomes were analyzed relative to CHD diagnoses and management. Patients with CL/P with (+CHD) were compared to those without (-CHD) CHD using χ tests and analysis of variance.
Among 575 patients with CL/P, 83 (14.4%) had CHD. Congenital heart disease rates were significantly higher in patients with cleft palate (CP) compared to other cleft types (χ, = .009). Eighty-one (97.6%) out of 83 +CHD patients were diagnosed prior to initial CL/P surgical assessment. Twenty-three (27.7%) +CHD patients required surgical repair of 10 cardiac anomalies prior to cleft care. Congenital heart disease was associated with delayed CP repair and increased rates of fistula in isolated patients with CP.
Congenital heart disease is known to be more prevalent in patients with CL/P. These data suggest the condition is particularly increased in patients with CP. Severe forms of CHD are diagnosed and treated prior to cleft care however postoperative fistula may be more common in patients with CHD. Therefore, careful attention is required for patient optimization and palatal flap dissection in patients with coexisting CHD and CL/P.
评估唇裂腭裂（CL/P）患者先天性心脏病（CHD）的特征，并评估其与唇腭裂结局的潜在关联。
对 2009 年至 2015 年期间接受初次唇裂治疗的所有 CL/P 患者进行回顾性研究。
洛杉矶儿童医院，一家三级医院。
排除标准包括微唇裂诊断、国际患者以及在其他机构接受初次修复后就诊的二次修复或修正患者。
分析患者的人口统计学、产前和出生特征、CL/P 特征、综合征状态、术后并发症和其他结局与 CHD 诊断和管理的关系。使用 χ 检验和方差分析比较唇腭裂合并 CHD（+CHD）患者和无 CHD（-CHD）患者。
在 575 例 CL/P 患者中，83 例（14.4%）患有 CHD。与其他唇裂类型相比，腭裂患者（CP）的先天性心脏病发生率明显更高（χ 2 ，=.009）。83 例+CHD 患者中，81 例（97.6%）在初次 CL/P 手术评估前被诊断出患有 CHD。23 例（27.7%）+CHD 患者在接受唇裂治疗前需要修复 10 种心脏异常。先天性心脏病与 CP 修复延迟和单纯 CP 患者瘘管发生率增加有关。
已知先天性心脏病在唇裂腭裂患者中更为常见。这些数据表明，CP 患者中该疾病的发生率尤其高。尽管严重形式的 CHD 在接受唇裂治疗前被诊断和治疗，但在合并 CHD 和 CL/P 的患者中，术后瘘管可能更为常见。因此，对于合并 CHD 和 CL/P 的患者，需要仔细关注患者的优化和腭瓣解剖。
