Mahle W T, Rychik J, Weinberg P M, Cohen M S
The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, 19104, USA.
J Am Coll Cardiol. 1998 Dec;32(7):1951-4. doi: 10.1016/s0735-1097(98)00457-4.
We sought to characterize the growth of the reconstructed aortic arch after the Norwood operation (NO).
The first stage of surgical palliation of hypoplastic left heart syndrome (HLHS), the NO, includes augmentation of the aortic arch with homograft. Growth characteristics of the reconstructed aortic arch, which is comprised of both native aortic tissue and homograft, have not been characterized.
Retrospectively, we examined the serial echocardiograms of 50 patients with HLHS who underwent NO to determine the diameter of the reconstructed transverse arch. Measurements were taken immediately after NO and at two other points (1 to 11 years of age). In addition, the autopsy specimens of 10 other patients with HLHS who underwent NO were examined to determine the contribution of native aortic tissue to the overall size of the reconstructed arch at the time of death (12 to 34 months).
The diameter of the transverse aorta increased after NO in all subjects. Its rate of growth paralleled that seen in the normal population, though the reconstructed arch had a significantly larger diameter throughout childhood. Examination of autopsy specimens demonstrated a mean increase in circumference of the native aortic tissue of 0.67 cm (p value <0.01), whereas there was no significant change in homograft circumference.
After reconstruction of the aortic arch in HLHS, the diameter of the arch continues to increase throughout childhood, and this increase is due to growth of the native aortic tissue.
我们试图描述诺伍德手术（NO）后重建主动脉弓的生长情况。
左心发育不全综合征（HLHS）外科姑息治疗的第一阶段，即NO，包括用同种异体移植物扩大主动脉弓。由天然主动脉组织和同种异体移植物组成的重建主动脉弓的生长特征尚未明确。
我们回顾性地检查了50例接受NO的HLHS患者的系列超声心动图，以确定重建横弓的直径。在NO后即刻以及另外两个时间点（1至11岁）进行测量。此外，检查了另外10例接受NO的HLHS患者的尸检标本，以确定死亡时（12至34个月）天然主动脉组织对重建弓整体大小的贡献。
所有受试者在NO后横主动脉直径均增加。其生长速率与正常人群相似，尽管在整个儿童期重建弓的直径明显更大。尸检标本检查显示天然主动脉组织的周长平均增加0.67 cm（p值<0.01），而同种异体移植物周长无显著变化。
HLHS患者主动脉弓重建后，弓的直径在整个儿童期持续增加，且这种增加是由于天然主动脉组织的生长。
