Cobanoglu A, Dobbs J L
Division of Cardiopulmonary Surgery, Oregon Health Sciences University, Portland 97201-3098, USA.
Eur J Cardiothorac Surg. 1996;10(2):116-9. doi: 10.1016/s1010-7940(96)80133-3.
Critical aortic stenosis has been a challenging congenital heart defect in the neonate commonly due to severe circulatory failure and multiple organ dysfunction. Since January, 1982, 20 neonates with a mean age of 5.6 +/- 1.6 days and weight of 3.25 +/- 0.1 kg underwent aortic commissurotomy. Early surgical intervention, cardiopulmonary bypass with hypothermia at 30 degrees C, careful assessment of the aortic leaflets, commissures and sinuses, and extensive commissurotomy short of causing aortic regurgitation, were essential principles of the operation. There were three operative deaths (15.0%) and three late deaths. One-year and 7-year survival rates are 74 +/- 10% and 69 +/- 11%. There were five reoperations for recurrent stenosis and two of these are late deaths. At 7 years 80 +/- 11% of patients remain free of a reoperation. Growth curves of survivors have been excellent with only two patients below the 5th percentile for both height and weight; 80% of the patients are totally asymptomatic. Despite substantial improvements in the treatments of most heart defects in neonates in the past decade, critical aortic stenosis still carries a malignant behavior with significant early mortality and the need for reoperations. Close follow-up of the patients is essential due to recurrence of the stenosis and progressive left ventricular hypertrophy, even when patients are totally asymptomatic.
重症主动脉瓣狭窄一直是新生儿具有挑战性的先天性心脏缺陷，通常是由于严重的循环衰竭和多器官功能障碍所致。自1982年1月以来，20例平均年龄为5.6±1.6天、体重为3.25±0.1kg的新生儿接受了主动脉瓣交界切开术。早期手术干预、30℃低温体外循环、仔细评估主动脉瓣叶、瓣交界和窦以及在不引起主动脉瓣反流的情况下进行广泛的交界切开术，是该手术的基本原则。有3例手术死亡（15.0%）和3例晚期死亡。1年和7年生存率分别为74±10%和69±11%。有5例因再发狭窄进行了再次手术，其中2例为晚期死亡。7岁时，80±11%的患者无需再次手术。幸存者的生长曲线良好，只有2例患者的身高和体重低于第5百分位数；80%的患者完全无症状。尽管在过去十年中新生儿大多数心脏缺陷的治疗有了实质性改善，但重症主动脉瓣狭窄仍然具有恶性行为，早期死亡率高且需要再次手术。由于狭窄复发和进行性左心室肥厚，即使患者完全无症状，对患者进行密切随访也是至关重要的。
