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贝里综合征;新生儿期一期修复成功,9年后评估结果,病例报告

Berry syndrome; a successful one-stage repair in neonate periods, evaluation result after 9 years, a case report.

作者信息

Habibie Yopie Afriandi, Busro Pribadi Wiranda, Roebiono Poppy S, Fakhri Dicky

机构信息

Division of Thoracic Cardiac and Vascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Syiah Kuala, The Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia.

Division of Pediatric and Congenital Cardiac Surgery, Dept of Thoracic and Cardiovascular Surgery, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.

出版信息

Ann Med Surg (Lond). 2021 Mar 4;64:102200. doi: 10.1016/j.amsu.2021.102200. eCollection 2021 Apr.

Abstract

BACKGROUD

IAA with an intact ventricular septum is distinctly unusual. Combination with an Aortopulmonary Window (APW), ascending aortic origin of the right pulmonary artery and PDA may be present which is called as Berry syndrome, a rare combination of cardiac anomalies, reported to be 0.046%, lethal combination and die shortly after birth.

CASE REPORT

We report a 9 days-old male neonates weighing 3.85 kg was referred by local hospital to our center and was ventilated with history of respiratory distress and severe infection since he was born. Admitted to our PCICU, 2D echo showed an IAA type A associated with a huge APW type II and restrictif PDA. A PGE1 infusion was started, during the following days the baby experienced several epileptic episodes. After improvement of the clinical condition, surgery was performed on the 20th days of life on year 2011. A successful one-stage repair of such anomalies in which cutting of PDA that arised from PA trunk and distally becoming into descending aorta, extended end to end anastomosis to conduct the ascending aortic blood flow into the descending aorta and intra arterial baffle was used. A 4-0 Gore-Tex baffle was used both to close the APW and separated the RPA from aortic origin with a good result, as his recently grown up as a cheerful 9 year old child who is growing actively and has entered elementary school in grade 2.

CONCLUSION

Berry syndrome is a rare but well-identified and surgically correctable anomaly. Early diagnosis and surgical treatment to avoid irreversible pulmonary hypertension is mandatory.

摘要

背景

室间隔完整的主动脉弓中断(IAA)极为罕见。可能合并主动脉肺动脉窗(APW)、右肺动脉起源于升主动脉及动脉导管未闭(PDA),这种情况被称为贝里综合征,是一种罕见的心脏畸形组合,据报道发生率为0.046%,是一种致命组合,患儿出生后不久即死亡。

病例报告

我们报告一例9日龄、体重3.85千克的男婴,由当地医院转诊至我院。自出生起即有呼吸窘迫和严重感染病史,一直使用呼吸机辅助通气。收入我院小儿重症监护病房(PCICU)后,二维超声心动图显示为A型IAA,合并巨大的II型APW及限制性PDA。开始静脉输注前列腺素E1(PGE1),在接下来的几天里,患儿出现多次癫痫发作。临床情况改善后,于2011年患儿出生后第20天行手术治疗。成功进行了一期修复手术,即切断起源于肺动脉主干并向远端延续为降主动脉的PDA,进行端端吻合以引导升主动脉血流进入降主动脉,并使用动脉内挡板。使用4-0 Gore-Tex挡板关闭APW并将右肺动脉与主动脉起源分离,效果良好,该患儿现已成长为一名开朗的9岁儿童,生长发育正常,已进入小学二年级。

结论

贝里综合征虽罕见,但可明确诊断且可通过手术矫正。必须尽早诊断并进行手术治疗以避免不可逆的肺动脉高压。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fd4a/7941068/f52dc0da2460/gr1.jpg

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