Chen Qiang, Fleming Thomas, Caputo Massimo, Stoica Serban, Tometzki Andrew, Parry Andrew
Department of Pediatric Cardiothoracic Surgery, Hong Kong Children's Hospital, Hong Kong, China.
Department of Cardiac Surgery, Bristol Royal Hospital for Children, University of Bristol, Bristol, UK.
Interdiscip Cardiovasc Thorac Surg. 2024 Dec 3;39(6). doi: 10.1093/icvts/ivae185.
A significant number of low-birth-weight neonates are born with aortic coarctation. Previous studies of early operation on these patients have shown a high hospital mortality and recurrence at 1 year. We reviewed our data to ascertain whether modern approaches allow better outcomes for these children.
Fourteen patients weighing <2 kg with isolated coarctation between January 2005 and December 2015 were studied by retrospective chart review to ensure >5 years follow-up. All patients underwent extended end-to-side surgical repair. In-hospital and medium-term follow-up data were collected. Data are expressed as median (range).
Weight at the time of surgery was 1.8 (1.5-1.9) kg. There were no deaths, in-hospital or during follow-up. In-hospital stay was 11 (4-47) days. At follow-up of 141 (80-207) months echocardiographic velocity across the repair was 1.6 (0.9-3.8) m/s. Two patients required balloon dilatations for recoarctation including 1 with William's syndrome who required balloon coarctoplasty followed by stenting. This patient had grossly abnormal vessels at the time of initial surgery with aortic wall thickness >3 mm. There were no central neurological complications. Other complications included vocal cord dysfunction in 1, development of chylothorax requiring prolonged chest drainage in 2, pneumothorax following chest drain removal in 1 and wound dehiscence in 1 patient.
Neonates below 2 kg can undergo coarctation repair safely with low incidence of recurrence. Waiting for growth in this cohort of patients may not therefore be justified.
大量低体重新生儿出生时患有主动脉缩窄。先前对这些患者进行早期手术的研究显示，1年时医院死亡率和复发率较高。我们回顾了我们的数据，以确定现代方法是否能为这些儿童带来更好的结果。
通过回顾性病历审查，对2005年1月至2015年12月期间体重<2kg且患有孤立性缩窄的14例患者进行研究，以确保随访时间>5年。所有患者均接受了扩大的端侧手术修复。收集了住院期间和中期随访数据。数据以中位数（范围）表示。
手术时体重为1.8（1.5-1.9）kg。住院期间及随访期间均无死亡。住院时间为11（4-47）天。在141（80-207）个月的随访中，修复部位的超声心动图速度为1.6（0.9-3.8）m/s。2例患者因再缩窄需要球囊扩张，其中1例患有威廉姆斯综合征，需要球囊缩窄成形术并置入支架。该患者初次手术时血管严重异常，主动脉壁厚度>3mm。无中枢神经系统并发症。其他并发症包括1例声带功能障碍、2例乳糜胸需要长时间胸腔引流、1例拔除胸腔引流管后气胸和1例伤口裂开。
2kg以下的新生儿可以安全地进行缩窄修复，复发率低。因此，在这组患者中等待生长可能不合理。
