Lambert V, Touchot A, Losay J, Piot J D, Henglein D, Serraf A, Lacour-Gayet F, Planche C
Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
Circulation. 1996 Nov 1;94(9 Suppl):II38-43.
Immediate results after surgical repair of the anomalous origin of the coronary artery are well known, but few studies reported midterm results in a relatively large population.
Between 1980 and 1995, 39 consecutive patients with anomalous origin of the coronaries artery from the pulmonary artery had restoration of a two-coronary-artery system. Median age at surgery was 18.5 months (range, 2.7 months to 38 years). Left ventricular (LV) function was normal in 13 patients. Direct aortic implantation was performed in 34 patients (87%), associated with mitral valvuloplasty in 3 patients. Hospital death occurred in 5 patients (13%; 70% confidence limits [CL], 8 to 20). Two patients were lost to follow-up. Mean follow-up was 40 +/- 42 months. There was no late death after 1 month, and the survival rate was 84% (70% CL, 67 to 93). One patient had a mitral valvuloplasty 18 months after reimplantation. At the last follow-up, LV shortening fraction (SF) was normal in 86% (70% CL, 61 to 96), but LV dilation persisted in 73% of patients, and 12 of the survivors (39%) had abnormal regional wall motion of the left ventricle. A perfusion defect with incomplete redistribution was observed in 8 patients on thallium-201 imaging performed in 45% of survivors. Total mortality was related only to the preoperative SF: 12% versus 24.8% (P < .05). No factor was related to SF recovery.
Despite no late deaths and SF recovery, LV dilation and ischemic segments of the left ventricle persisted at the long-term follow-up.
冠状动脉异常起源手术修复后的即刻结果已广为人知，但在相对较大规模人群中报道中期结果的研究较少。
1980年至1995年间，39例冠状动脉起源于肺动脉的连续患者恢复了双冠状动脉系统。手术时的中位年龄为18.5个月（范围为2.7个月至38岁）。13例患者左心室（LV）功能正常。34例患者（87%）进行了直接主动脉植入，其中3例同时进行了二尖瓣成形术。5例患者（13%；70%可信区间[CL]，8%至20%）发生医院死亡。2例患者失访。平均随访时间为40±42个月。1个月后无晚期死亡，生存率为84%（70%CL，67%至93%）。1例患者在再植入18个月后进行了二尖瓣成形术。在最后一次随访时，86%（70%CL，61%至96%）的患者左心室缩短分数（SF）正常，但73%的患者左心室扩张持续存在，12例幸存者（39%）左心室节段性室壁运动异常。在45%的幸存者中进行的铊-201心肌显像显示，8例患者存在灌注缺损且再分布不完全。总死亡率仅与术前SF相关：12%对24.8%（P<.05）。没有因素与SF恢复相关。
尽管无晚期死亡且SF恢复，但在长期随访中左心室扩张和左心室缺血节段持续存在。
