Sade R M, Crawford F A, Hohn A R
Ann Thorac Surg. 1982 Jun;33(6):570-5. doi: 10.1016/s0003-4975(10)60815-6.
Twenty-nine patients have had valvotomy with inflow occlusion since 1975 at our institution: 7 for aortic stenosis and 22 for pulmonary stenosis. All patients with aortic stenosis and 11 with pulmonary stenosis were neonates. Six patients died, 3 with aortic stenosis and 3 with pulmonary stenosis. All of them were less than 2 days old. Two newborns with critical pulmonary stenosis required reoperation with an outflow patch at age 22 and 25 months. To determine morbidity and expense of inflow occlusion versus cardiopulmonary bypass for patients with pulmonary stenosis, we compared the 11 patients who were not infants and who had inflow occlusion (age range, 3.5 to 26.8 years) with 10 patients who were operated on concurrently and who required bypass to correct associated minor intracardiac lesions (age range, 2.6 to 26.4 years). Significant differences (p less than 0.01) were as follows (inflow occlusion versus bypass): operating room time, 2.0 +/- 0.4 versus 3.6 +/- 0.8 hours (mean +/- standard deviation); blood utilized, 0.3 +/- 0.5 versus 1.7 +/- 1.7 units; and total expense, $4,600 +/- 800 versus $7,000 +/- 1,600. Thus, inflow occlusion is safe in patients more than 2 days old, with early and late results similar to bypass, and is an attractive alternative for patients with isolated pulmonary valvular stenosis and for newborns with aortic stenosis.
自1975年以来，我院有29例患者在流入道阻断下接受了瓣膜切开术：7例为主动脉瓣狭窄，22例为肺动脉瓣狭窄。所有主动脉瓣狭窄患者和11例肺动脉瓣狭窄患者均为新生儿。6例患者死亡，3例主动脉瓣狭窄，3例肺动脉瓣狭窄。他们均小于2日龄。2例患有严重肺动脉瓣狭窄的新生儿分别在22个月和25个月时需要再次手术并植入流出道补片。为了确定流入道阻断与体外循环治疗肺动脉瓣狭窄患者的发病率和费用，我们将11例非婴儿且接受流入道阻断的患者（年龄范围为3.5至26.8岁）与10例同期接受手术且需要体外循环纠正相关轻微心内病变的患者（年龄范围为2.6至26.4岁）进行了比较。显著差异（p<0.01）如下（流入道阻断与体外循环）：手术室时间，2.0±0.4小时对3.6±0.8小时（均值±标准差）；用血量，0.3±0.5单位对1.7±1.7单位；总费用，4600±800美元对7000±1600美元。因此，对于年龄超过2日龄的患者，流入道阻断是安全的，其早期和晚期结果与体外循环相似，对于孤立性肺动脉瓣狭窄患者和主动脉瓣狭窄新生儿来说是一种有吸引力的替代方法。
