Blackstone E H, Kirklin J W, Bradley E L, DuShane J W, Appelbaum A
J Thorac Cardiovasc Surg. 1976 Nov;72(5):661-79.
The hospital mortality rate was 9.1 per cent (three deaths) in 33 patients less than 2 years old undergoing primary repair of single large ventricular septal defects (VSD's) since January 1972, and was not related to age; it was zero in 50 patients older than 2 years (Group A). The mortality rate with multiple VSD's was 36.4 per cent, not related to age. Age at operation, preoperative pulmonary vascular resistance, and pulmonary artery pressure were directly related to mean pulmonary artery pressure 5 or more years later in 74 patients (Group B) operated upon between 1955 and 1968. Over-all probability of "surgical cure" for single large VSD (surviving the early and late postoperative period with normal or near-normal pulmonary artery pressure 5 years later) is 92 per cent when pulmonary vascular resistance is 4 units - sq. M. and operation performed at age 27 months, 87 per cent when resistance is 8 and operation done at age 6 months, and 80 per cent when resistance is 12 and operation done at less than 6 months of age. These and other probability curves are examined and compared with natural history to determine optimal age for elective repair for large VSD's.
自1972年1月以来，33例年龄小于2岁的单纯大型室间隔缺损（VSD）患儿接受一期修补手术，医院死亡率为9.1%（3例死亡），且与年龄无关；50例年龄大于2岁的患儿（A组）死亡率为零。多发VSD的死亡率为36.4%，与年龄无关。1955年至1968年间接受手术的74例患儿（B组），手术时年龄、术前肺血管阻力和肺动脉压力与术后5年或更长时间的平均肺动脉压力直接相关。当肺血管阻力为4单位-平方米且手术在27个月龄时进行，单纯大型VSD“手术治愈”（术后早期和晚期存活且5年后肺动脉压力正常或接近正常）的总体概率为92%；当阻力为8且手术在6个月龄时进行，概率为87%；当阻力为12且手术在小于6个月龄时进行，概率为80%。对这些及其他概率曲线进行了研究，并与自然病程进行比较，以确定大型VSD择期修补的最佳年龄。
