Jones M, Barnhart G R, Morrow A G
Am J Cardiol. 1982 Sep;50(3):569-79. doi: 10.1016/0002-9149(82)90326-5.
The late results were evaluated of operations for the relief of left ventricular outflow tract obstruction in young patients, 1 to 18 years old, from the National Heart Institute who were followed up for at least 5 years and from recently reported studies with an average follow-up duration of 5 or more years. The operative mortality rate for the combined series was low: 1.9 percent of 522 patients with valvular aortic stenosis, 6.0 percent of 222 patients with fixed subvalvular aortic stenosis and 5.5 percent of 18 patients with hypertrophic subaortic stenosis. From the National Heart Institute series, gradients early postoperatively were decreased to less than 50 mm Hg in 88 percent (30 of 34) of patients with valvular, in 68 percent (15 of 22) of patients with subvalvular and in 88 percent (8 of 9) of patients with hypertrophic subaortic stenosis. Late survival rates for patients in the combined series were 90 percent (472 of 522), 86 percent (190 of 222), and 82 percent (14 of 17) in the three respective groups after mean follow-up periods of 5 to 14.4 years. All late survivors in the current series have had symptomatic improvement; 95 percent (58 of 61) are asymptomatic. However, actuarial analysis in these patients predicts that 50 +/- 8 percent of those with valvular and 44 +/- 10 percent of those with subvalvular aortic stenosis after 10 years will be free from the adverse postoperative events of residual or recurrent left ventricular outflow tract obstruction, clinically significant aortic regurgitation, reoperation, endocarditis or late death. With use of the same adverse postoperative events to determine satisfactory late results from the combined series, it was found that 54 percent (281 of 522) of those operated on for valvular, 54 percent (120 of 222) of those operated on for subvalvular and 78 percent (14 of 18) of those operated on for hypertrophic subaortic stenosis had satisfactory late results 5 to 14 years after operation. Of the patients having unsatisfactory late results, major hemodynamic abnormalities were detected in 55 percent (23 of 42) within 1 year postoperatively. Thus it appears that operations for many children with left ventricular outflow tract obstruction are palliative. These patients should have early postoperative assessment and continuing long-term follow-up evaluation during childhood, adolescence and adulthood.
对国立心脏研究所1至18岁的年轻患者进行左心室流出道梗阻解除手术的远期结果进行了评估，这些患者至少随访了5年，以及近期报道的平均随访时间为5年或更长时间的研究。联合系列的手术死亡率较低：522例瓣膜性主动脉狭窄患者中为1.9%，222例固定性瓣下主动脉狭窄患者中为6.0%，18例肥厚性主动脉瓣下狭窄患者中为5.5%。在国立心脏研究所的系列中，瓣膜性狭窄患者术后早期压差在88%（34例中的30例）中降至50 mmHg以下，瓣下狭窄患者中为68%（22例中的15例），肥厚性主动脉瓣下狭窄患者中为88%（9例中的8例）。联合系列患者的远期生存率在平均随访5至14.4年后，三组分别为90%（522例中的472例）、86%（222例中的190例）和82%（17例中的14例）。本系列所有远期存活者症状均有改善；95%（61例中的58例）无症状。然而，对这些患者的精算分析预测，瓣膜性狭窄患者10年后50±8%、瓣下主动脉狭窄患者44±10%将无残余或复发性左心室流出道梗阻、临床上显著的主动脉瓣反流、再次手术、心内膜炎或晚期死亡等不良术后事件。使用相同的不良术后事件来确定联合系列的满意远期结果时，发现瓣膜性手术患者中有54%（522例中的281例）、瓣下手术患者中有54%（222例中的120例）、肥厚性主动脉瓣下狭窄手术患者中有78%（18例中的14例）在术后5至14年有满意的远期结果。在远期结果不满意的患者中，55%（42例中的23例）在术后1年内检测到主要血流动力学异常。因此，对于许多左心室流出道梗阻的儿童进行的手术似乎是姑息性的。这些患者术后应尽早进行评估，并在儿童期、青春期和成年期进行持续的长期随访评估。
