Pelech A N, Dyck J D, Trusler G A, Williams W G, Olley P M, Rowe R D, Freedom R M
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 1987 Oct;94(4):510-7.
The factors associated with survival in 40 neonates (age less than 28 days) with critical aortic stenosis undergoing either open (22 patients) or closed (18 patients) transventricular aortic valvotomy were reviewed. Significant adverse correlates with survival included evidence of poor perfusion preoperatively (low pH, greater than Grade 2/6 soft ejection systolic murmur) and marked congestive heart failure (hepatomegaly, cardiomegaly, elevated left atrial pressure). Congenital mitral stenosis (anulus less than 11 mm), a small aortic anulus (less than 6.5 mm), and failure to achieve an adequate aortic orifice (greater than 6 mm), at operation were identified as factors associated with increased mortality. Initial perioperative survival was better with closed aortic valvotomy. However, there was no significant difference in overall operative survival between closed (9/18, 50%) and open (8/22, 36%) aortic valvotomy (p = 0.26). The incidence of early reoperation (less than 1 year of age) was greater in perioperative survivors undergoing closed valvotomy (7/13, 54%) rather than open valvotomy (1/10, 10%) (p less than 0.05). In conclusion, long-term survival among patients with critical neonatal aortic valve stenosis remains disturbingly low (13/40, 32%) and has not significantly improved over the past 20 years.
回顾了40例患有严重主动脉瓣狭窄的新生儿（年龄小于28天）接受开放（22例患者）或闭合（18例患者）经心室主动脉瓣切开术的生存相关因素。与生存显著相关的不良因素包括术前灌注不良的证据（低pH值、大于2/6级柔和喷射性收缩期杂音）和明显的充血性心力衰竭（肝肿大、心脏扩大、左心房压力升高）。先天性二尖瓣狭窄（瓣环小于11毫米）、小主动脉瓣环（小于6.5毫米）以及手术时未能达到足够的主动脉瓣口（大于6毫米）被确定为与死亡率增加相关的因素。闭合性主动脉瓣切开术的围手术期初始生存率更高。然而，闭合性（9/18，50%）和开放性（8/22，36%）主动脉瓣切开术的总体手术生存率无显著差异（p = 0.26）。接受闭合性瓣膜切开术的围手术期幸存者（7/13，54%）比接受开放性瓣膜切开术的患者（1/10，10%）早期再次手术（年龄小于1岁）的发生率更高（p小于0.05）。总之，患有严重新生儿主动脉瓣狭窄的患者长期生存率仍然低得令人不安（13/40，32%），并且在过去20年中没有显著改善。
