Department of Pediatrics, Division of Cardiology, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts, USA.
Department of Pediatrics, Division of Cardiology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Echocardiography. 2024 May;41(5):e15832. doi: 10.1111/echo.15832.
In infants with complete atrioventricular canal (CAVC) defects, post-operative left atrioventricular valve regurgitation (LAVVR) is a known major cause of morbidity and mortality and a common indication for re-operation. However, there is scarce data to identify risk factors for poor outcomes. Our study aims to find echocardiographic characteristics that predict post-operative LAVVR at discharge and 1-year follow-up.
Retrospective cohort study of patients with initial CAVC repair at our hospital who were followed for 1 year between 2013 and 2022. Patients with major co-morbid conditions were excluded. Serial echocardiograms were reviewed. Anatomic details, quantitative and qualitative measure of LAVVR including the number of regurgitant jets, regurgitant jet length and vena contracta width, and ventricular function were collected. The time points measured include pre-operative transthoracic echocardiogram (TTE), post-operative transesophageal echocardiogram (PO-TEE), routine protocol based post-operative day 1 (POD1) TTE, discharge TTE and 1-year post-operative (1yPO) TTE. Paired t-tests, chi-square analysis, and linear regression analysis were performed comparing measured variables to LAVVR outcomes.
Fifty-two patients were included; 92% had Trisomy 21. The majority were classified as Rastelli A (71%), others Rastelli C (29%). Only two patients had moderate or greater LAVVR pre-operatively. The mean age at repair was 125 ± 44 days. Pre-operative LAVVR was the only significant predictor of LAVVR severity at 1 year after backward stepwise regression. Of those with < moderate LAVVR on PO-TEE, 20% had worsening to ≥ moderate at discharge, but only 9% remained that way at 1 year. Of those with ≥ moderate LAVVR on PO-TEE, 40% improved to < moderate by 1 year. Two patients who worsened at 1 year, both secondary to likely cleft suture dehiscence. Only one patient required reoperation in the immediate post-operative period secondary to severe LAVVR due to suture dehiscence. Routine protocol-based POD1 echo did not have any association with altered outcomes.
Pre-operative LAVVR was the only significant predictor of LAVVR severity at 1 year. A significant percentage (40%) of patient with ≥ moderate LAVVR on PO-TEE improved to < moderate by 1 year. Furthermore, routine protocol-based POD1 echo did not have any association with altered outcomes.
在患有完全性房室管缺损（CAVC）的婴儿中，术后左房室瓣反流（LAVVR）是导致发病率和死亡率的主要原因之一，也是常见的再次手术指征。然而，目前尚缺乏识别不良预后风险因素的数据。我们的研究旨在寻找预测术后 LAVVR 出院和 1 年随访的超声心动图特征。
对 2013 年至 2022 年期间在我院接受初次 CAVC 修复的患者进行回顾性队列研究，排除有重大合并症的患者。对连续的超声心动图进行回顾性分析。收集解剖学细节、LAVVR 的定量和定性测量，包括反流射流数量、反流射流长度和收缩期瓣口宽度，以及心室功能。测量的时间点包括术前经胸超声心动图（TTE）、术后经食管超声心动图（PO-TEE）、术后第 1 天（POD1）常规方案 TTE、出院 TTE 和术后 1 年（1yPO）TTE。比较测量变量与 LAVVR 结果，采用配对 t 检验、卡方分析和线性回归分析。
共纳入 52 例患者，92%患有 21 三体综合征。大多数患者为 Rastelli A 型（71%），其他为 Rastelli C 型（29%）。仅 2 例患者术前存在中度或以上 LAVVR。修复时的平均年龄为 125±44 天。术前 LAVVR 是术后 1 年 LAVVR 严重程度的唯一显著预测因素。在 PO-TEE 检查中<中度 LAVVR 的患者中，20%在出院时恶化至≥中度，但只有 9%在 1 年时仍保持这种情况。在 PO-TEE 检查中≥中度 LAVVR 的患者中，40%在 1 年内改善至<中度。有 2 例患者在 1 年内恶化，均归因于可能的裂隙缝线裂开。仅 1 例患者因缝线裂开导致严重 LAVVR 而在术后即刻再次手术。基于常规方案的 POD1 超声心动图与改变的结果没有任何关联。
术前 LAVVR 是术后 1 年 LAVVR 严重程度的唯一显著预测因素。在 PO-TEE 检查中≥中度 LAVVR 的患者中，40%在 1 年内改善至<中度。此外，基于常规方案的 POD1 超声心动图与改变的结果没有任何关联。
