Seghaye M C, Grabitz R, Alzen G, Trommer F, Hörnchen H, Messmer B J, von Bernuth G
Department of Paediatric Cardiology, Aachen University of Technology, Germany.
Acta Paediatr. 1997 Feb;86(2):213-6. doi: 10.1111/j.1651-2227.1997.tb08871.x.
Thirty-six children (median chronological age 6 years 1 month) who had undergone surgical closure of a patent ductus arteriosus through a left posterolateral thoracotomy in the neonatal period (median gestational age 32 weeks) were investigated prospectively with respect to anatomical and functional changes of the chest. At follow-up examination, residual or recurrent patent ductus arteriosus was not observed. Three patients had chronic bronchial obstruction. Two patients showed pathological musculoskeletal thoracic sequelae that did not require any treatment at the time of follow-up; persistence of immediate postoperative left phrenic palsy (n = 1) and thoracic scoliosis (n = 1). Twenty of the 27 patients in whom chest X-ray was performed had minor radiological skeletal anomalies in the form of rib deformation or fusion related to the thoracotomy, lesions which have a potential to induce thoracic scoliosis. Left shoulder elevation at chest X-ray and isolated left arm dysfunction at clinical examination were not observed. Despite the low incidence of scoliosis and the absence of left arm dysfunction observed at mid-term follow-up in our series, the incidence of minor rib deformations with a potential to induce severe anomalies such as scoliosis should motivate late follow-up examination at adolescence to definitively assess the prevalence of thoracic sequelae after surgical closure of the patent ductus arteriosus in premature infants.
三十六名儿童（年龄中位数为6岁1个月）在新生儿期（孕周中位数为32周）通过左后外侧开胸手术进行了动脉导管未闭的手术闭合，对其胸部的解剖和功能变化进行了前瞻性研究。在随访检查中，未观察到残余或复发性动脉导管未闭。三名患者患有慢性支气管阻塞。两名患者出现病理性肌肉骨骼胸部后遗症，在随访时无需任何治疗；术后即刻持续性左膈神经麻痹（n = 1）和胸椎侧弯（n = 1）。在进行胸部X光检查的27名患者中，有20名存在与开胸手术相关的肋骨变形或融合形式的轻微放射学骨骼异常，这些病变有可能诱发胸椎侧弯。胸部X光检查未发现左肩抬高，临床检查也未发现孤立的左臂功能障碍。尽管在我们的系列研究中，中期随访时脊柱侧弯的发生率较低且未观察到左臂功能障碍，但具有诱发脊柱侧弯等严重异常可能性的轻微肋骨变形的发生率应促使在青春期进行后期随访检查，以明确评估早产儿动脉导管未闭手术闭合后胸部后遗症的患病率。
