Portman M A, Beder S D, Ankeney J L, van Heeckeren D, Liebman J, Riemenschneider T A
Am Heart J. 1985 Nov;110(5):1054-8. doi: 10.1016/0002-8703(85)90209-1.
Between July, 1963, and July, 1983, a total of 69 patients (35 boys and 34 girls) underwent ostium primum defect repair. There were four perioperative deaths and four patients were subsequently lost to follow-up, leaving 61 children followed for 6 months to 20 years (mean 5 years). Results of surgery were assessed by cardiac catheterization in 17 of 61 patients, while the remaining patients were evaluated noninvasively. Postoperative mitral insufficiency was found to be absent in 19 patients, mild to trivial in 35, moderate in four, and severe in two. Four patients were found to have large residual atrial septal defects. Significant late postoperative arrhythmias were found in 14 of 61 patients. The types of arrhythmias included isolated complete atrioventricular block in 5 of 14, complete atrioventricular block with sinus node dysfunction in 2 of 14, and isolated sinus node dysfunction in 7 of 14. Pacemakers have been implanted in 8 of 14 of these patients. Based on this 20-year review of a large number of children: (1) ostium primum defect repair is associated with a low mortality rate, (2) residual mitral insufficiency although common is usually mild to trivial and nonprogressive, and (3) significant arrhythmias are a frequent complication and often require pacemaker implantation.
在1963年7月至1983年7月期间，共有69例患者（35名男孩和34名女孩）接受了原发孔缺损修复手术。围手术期死亡4例，4例患者随后失访，剩余61名儿童随访时间为6个月至20年（平均5年）。61例患者中有17例通过心导管检查评估手术结果，其余患者采用非侵入性评估。发现19例患者术后无二尖瓣关闭不全，35例为轻度至轻微二尖瓣关闭不全，4例为中度，2例为重度。发现4例患者有较大的残余房间隔缺损。61例患者中有14例术后出现明显的晚期心律失常。心律失常类型包括14例中的5例孤立性完全性房室传导阻滞、14例中的2例完全性房室传导阻滞合并窦房结功能障碍以及14例中的7例孤立性窦房结功能障碍。这些患者中有14例中的8例已植入起搏器。基于对大量儿童的这20年回顾：（1）原发孔缺损修复手术死亡率较低；（2）残余二尖瓣关闭不全虽然常见，但通常为轻度至轻微且无进展性；（3）明显的心律失常是常见并发症，且常需要植入起搏器。
