Geissler H J, Südkamp M, Nowak J, de Vivie E R
Klinik und Poliklinik für Herzchirurgie, Universität zu Köln.
Z Kardiol. 1996 Oct;85(10):782-9.
Adolescents and adults with congenital heart disease have become a new, continuously growing group of patients, because currently improved diagnostics and therapy allow the majority of newborns with congenital heart disease to survive to adulthood. The objective of this retrospective study was to investigate lethality and morbidity after surgery for congenital heart disease in adolescents and adults. Between 1989 and 1994, we operated 137 patients (age between 15 and 75 years; mean 33.8 +/- 15.1) because of congenital heart disease. This was equivalent to 2.7% of all patients, who were operated during this period of time. 101 cases were primary operations, in 36 cases (26.3%) a reoperation was performed. The most frequent diagnoses were ostium-secundum-defect (37.9%), anomalies of the aortic valve including sub- and supravalvular stenoses (9.5%), anomalies of the mitral valve (8%), ventricular septal defect (7.3%) and aortic coarctation (7.3%). Overall lethality was 5.8%, including emergency cases and all late deaths, which have been reported so far. Evaluation of morbidity showed an intraoperative cardiac low-output-syndrome in 3.7%, pulmonary failure in 5.8%, postoperative renal failure in 4.4% and postoperative bleeding complications in 7.3% of cases. Mean duration of postoperative ventilation and intensive care treatment were 2.3 +/- 5.3 and 3.6 +/- 7.3 d, respectively. In comparison to their preoperative status, 71% of patients had improved by one or two NYHA classes. We found that the higher perioperative risk related to reoperation had no impact on the operation's functional result, as evaluation of postoperative functional class showed no difference between primary and re-do cases. The general term congenital heart disease describes a very inhomogeneous group of patients with a broad spectrum of different diagnoses. The variable morphology and pathophysiology of the different congenital heart defects require an individual surgical strategy for each patient, in rare cases even the decision for a heart- or heart-lung-transplantation. Furthermore, adequate follow-up and competent ambulatory treatment of these patients require the cooperation of pediatric and adult cardiologists and cardiac surgeons in interdisciplinary outpatient clinics.
患有先天性心脏病的青少年和成年人已成为一个新的、持续增长的患者群体，因为目前诊断和治疗方法的改进使大多数患有先天性心脏病的新生儿能够存活至成年。这项回顾性研究的目的是调查青少年和成年人先天性心脏病手术后的死亡率和发病率。1989年至1994年间，我们为137例（年龄在15至75岁之间；平均33.8±15.1岁）先天性心脏病患者实施了手术。这相当于在此期间接受手术的所有患者的2.7%。101例为初次手术，36例（26.3%）进行了再次手术。最常见的诊断为继发孔型缺损（37.9%）、主动脉瓣异常（包括瓣下和瓣上狭窄）（9.5%）、二尖瓣异常（8%）、室间隔缺损（7.3%）和主动脉缩窄（7.3%）。总体死亡率为5.8%，包括急诊病例和迄今报告的所有晚期死亡病例。发病率评估显示，术中发生心脏低输出综合征的病例占3.7%，肺衰竭占5.8%，术后肾衰竭占4.4%，术后出血并发症占7.3%。术后平均通气时间和重症监护治疗时间分别为2.3±5.3天和3.6±7.3天。与术前状况相比，71%的患者纽约心脏协会（NYHA）心功能分级提高了一级或两级。我们发现，与再次手术相关的围手术期较高风险对手术的功能结果没有影响，因为术后功能分级评估显示初次手术和再次手术病例之间没有差异。先天性心脏病这一统称描述了一组非常不均一的患者，其诊断范围广泛。不同先天性心脏缺陷的形态和病理生理各不相同，需要针对每个患者制定个体化的手术策略，在极少数情况下甚至需要决定进行心脏或心肺移植。此外，对这些患者进行充分的随访和专业的门诊治疗需要儿科和成人心脏病专家以及心脏外科医生在跨学科门诊诊所进行合作。
