Gaynor J W, Bull C, Sullivan I D, Armstrong B E, Deanfield J E, Taylor J F, Rees P G, Ungerleider R M, de Leval M R, Stark J
Cardiothoracic Unit, Hospital for Sick Children, London, England.
Ann Thorac Surg. 1995 Jul;60(1):122-5; discussion 125-6.
This study examined the late outcome after intervention for neonatal aortic valve stenosis.
Seventy-three neonates (59 boys and 14 girls) underwent intervention for critical aortic valve stenosis during the first 30 days of life at two institutions, The Hospital for Sick Children, London, and Duke University Medical Center, Durham, North Carolina. Procedures performed include closed valvotomy (n = 12), open valvotomy with inflow occlusion (n = 14), open valvotomy with cardiopulmonary bypass (n = 33), balloon valvotomy (n = 12), and other procedures (n = 2). The mean age at the first intervention was 8 +/- 1 days.
The hospital mortality was 52.1%. The mean duration of follow-up for the hospital survivors (n = 35) was 8.3 +/- 1.1 years. The actuarial survival for the hospital survivors was 93.3% +/- 4.7% at 10 years and 83.9% +/- 9.8% at 15 years, whereas event-free survival (reintervention, endocarditis, or early death) was 61.8% +/- 9.3% at 5 years, 34.2% +/- 10.8% at 10 years, and 27.4% +/- 10.6% at 15 years. Three patients have died and 11 patients have required aortic valve replacement during the follow-up period. The age at the initial intervention, the type of initial intervention, and the year of initial intervention were not predictive of early death or need for reintervention. At last follow-up, 26 of the long-term survivors (n = 32) were in functional class I and 6 were in functional class II.
Aortic stenosis in the neonatal period is a difficult problem with a high initial mortality. Late survival and functional class are excellent for patients surviving the initial hospitalization, but most require further intervention within 10 years.
本研究调查了新生儿主动脉瓣狭窄干预后的远期结局。
73例新生儿（59例男童和14例女童）于出生后30天内在两家机构接受了严重主动脉瓣狭窄的干预治疗，这两家机构分别是伦敦的大奥蒙德街儿童医院和北卡罗来纳州达勒姆的杜克大学医学中心。实施的手术包括闭式瓣膜切开术（n = 12）、入流阻断开胸瓣膜切开术（n = 14）、体外循环下开胸瓣膜切开术（n = 33）、球囊瓣膜切开术（n = 12）以及其他手术（n = 2）。首次干预时的平均年龄为8±1天。
医院死亡率为52.1%。医院存活者（n = 35）的平均随访时间为8.3±1.1年。医院存活者10年的精算生存率为93.3%±4.7%，15年为83.9%±9.8%，而无事件生存率（再次干预、心内膜炎或早期死亡）5年时为61.8%±9.3%，10年时为34.2%±10.8%，15年时为27.4%±10.6%。随访期间有3例患者死亡，11例患者需要进行主动脉瓣置换。首次干预时的年龄、首次干预的类型以及首次干预的年份均不能预测早期死亡或再次干预的需求。在最后一次随访时，32例长期存活者中有26例心功能为I级，6例为II级。
新生儿期主动脉狭窄是一个难题，初始死亡率很高。对于初次住院存活的患者，远期生存率和心功能分级良好，但大多数患者在10年内需要进一步干预。
