Yamaki S, Abe A, Endo M, Tanaka T, Tabayashi K, Takahashi T
Department of Cardiology, Katta General Hospital, Shiroishi, Japan.
Ann Thorac Surg. 1998 Nov;66(5):1560-4. doi: 10.1016/s0003-4975(98)00776-0.
Nineteen patients (mean age, 7.6 months) with a percent wall thickness of more than 33% in the small pulmonary arteries were found to have extremely thickened media. Based on our findings, a criterion of operative indication is proposed.
The percentage of extremely thickened media of small pulmonary arteries for all pulmonary arteries was determined on microscopic lung sections and was introduced as an index for operative indication.
Operative repair was performed in 16 patients: 9 died intraoperatively and 7 survived more than 12 months. In 4 of 5 patients that had pulmonary artery banding, medial hypertrophy remained despite pulmonary artery banding. Operative repair also had no positive effect. In operative and late deaths and in survivors without a decrease of pulmonary arterial pressure, the percentage of extremely thickened media of small pulmonary arteries was shown to be more than 10%, whereas in 5 survivors and 1 operative death with a significant postoperative decrease of pulmonary arterial pressure, the value was less than 7%.
If a patient has less than 7% of small pulmonary arteries with extremely thickened media, operative repair is likely to be effective. When the value is higher than 10%, not only operative repair but also pulmonary artery banding cannot be recommended because of ineffectiveness and hazard.
发现19例（平均年龄7.6个月）小肺动脉壁厚度百分比超过33%的患者存在中膜极度增厚。基于我们的研究结果，提出了手术指征标准。
在肺组织显微镜切片上确定所有肺动脉中小肺动脉中膜极度增厚的百分比，并将其作为手术指征指标。
16例患者接受了手术修复：9例术中死亡，7例存活超过12个月。在接受肺动脉环扎术的5例患者中，有4例尽管进行了肺动脉环扎术，但中膜肥厚仍然存在。手术修复也没有产生积极效果。在手术死亡和晚期死亡以及肺动脉压力未降低的存活者中，小肺动脉中膜极度增厚的百分比显示超过10%，而在5例存活者和1例术后肺动脉压力显著降低的手术死亡患者中，该值小于7%。
如果患者小肺动脉中膜极度增厚的比例小于7%，手术修复可能有效。当该值高于10%时，由于无效和风险，不仅不建议进行手术修复，也不建议进行肺动脉环扎术。
