摘要
目的分析室间隔缺损(VSD)致主动脉瓣脱垂患者的临床特征,对比手术治疗前、后心脏超声参数变化并分析患者手术治疗预后情况。方法连续入选北京安贞医院于2011年7月1日至2018年7月31日间进行手术治疗的VSD所致主动脉瓣脱垂患者21例为研究对象,收集研究对象的基线资料及心脏超声参数,获取VSD的位置及大小、左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)、左室射血分数(LVEF)及瓣膜返流情况,并对手术情况进行汇总,对围手术期不良事件(包括死亡、心力衰竭、再次手术)进行分析。结果21例患者中位年龄9岁,年龄1~54岁,男性比例71.4%,NYHA分级Ⅰ~Ⅱ患者占80.9%,Ⅲ级患者占19.1%。心脏超声结果:中或重度主动脉瓣返流占42.9%(9例);VSD:6例(29%)膜周部缺损,15例(71%)为漏斗部缺损,其中干下型占52%,嵴内型占19%,大小中位数为11 mm。手术情况:6例患者进行主动脉瓣人工瓣置换术,2例患者进行主动脉瓣成形术,有1例患者同时进行了二尖瓣人工瓣置换及三尖瓣成形术。研究对象术后左心室大小均较术前减少,但差异无明显统计学意义(P均>0.05)。与无或者轻度返流者相比,中重度返流者年龄偏大、左室内径大、手术过程中体外循环时间、升主动脉阻断时间及辅助机械通气时间更长(P均<0.05),但通过体表面积校正的左室内径两组差异无统计学意义(P>0.05)。围手术期有一例患者因多器官功能障碍死亡,余半年随访中无不良事件发生。结论室间隔缺损所致主动脉瓣脱垂患者中以漏斗部缺损最为常见,手术治疗总体预后较好,但在本研究中出现中-重度主动脉瓣返流者手术过程中体外循环时间、升主动脉阻断时间及辅助通气时间均较长,提示在未出现主动脉瓣返流前进行VSD手术对于这部分患者很重要。
Objective To analyze the clinical features of patients with aortic valve prolapse caused by ventricular septal defect(VSD),compare the changes of cardiac ultrasound parameters before and after surgical treatment,and analyze the prognosis of patients undergoing surgery.Methods Twenty-one patients with aortic valve prolapse and VSD were consecutively recruited in our hospital between Jul 1,2011 and Jul 31,2018.The clinical characteristics,including age,gender and comorbidities,were obtained.Meanwhile,echocardiography was performed for all the subjects and the diameter of left ventricular end diastolic diameter(LVEDD)and end systolic diameter(LVESD),left ventricular ejection fraction(LVEF),and aortic valve regurgitation,as well as VSD type and size were analyzed.All the patients were followed up till six months after surgery and the adverse events was recorded,including death,heart failure,and re-operation.Results The median age of 21 patients was 9 years old,ranged from 1 to 54 years old,and the proportion of males was 71.4%.Among them,patients with NYHA classⅠ~Ⅱaccounted for 80.9%,while patients with classⅢaccounted for 19.1%.Echocardiography results:42.9%of them have moderate or severe aortic regurgitation(9 cases);VSD:6 cases(29%)had perimembranous defects,15 cases(71%)with infundibular defects,which was more common,including 52%of subarterial VSD and 19%intracristal VSD.The median size was 11 mm.Surgery:6 patients underwent aortic valve replacement,2 patients with aortic valvuloplasty,and 1 patient with mitral valve replacement and tricuspid valvuloplasty.The left ventricular size of the study subjects was lower than that before surgery,but the difference was not statistically significant(P>0.05).Compared with those without or mild aortic valve regurgitation,the patients with moderate to severe regurgitation were older,with large left ventricular diameter,longer extracorporeal circulation time during surgery,ascending aorta occlusion time,and assisted mechanical ventilation(P<0.05).However,there was no significant difference in the left ventricular diameter corrected by body surface area(P>0.05).One patient in the perioperative period died of multiple organ dysfunction,and no adverse events occurred during the half-year follow-up.Conclusion In patients with aortic valve prolapse caused by ventricular septal defect,the infundibular defect is the most common,and the overall prognosis of surgical treatment is better.However,in this study,prolongation of operation time has been found in patients with moderate to severe aortic regurgitation,suggesting that VSD surgery prior to the absence of aortic regurgitation or the change of aortic leaf morphology is important for these patients.
作者
阮燕萍
张磊
刘晓伟
何怡华
Ruan Yanping;Zhang Lei;Liu Xiaowei;He Yihua(Department of Echocardiography,Fetal Heart Disease and Maternal Fetal Medicine Research Key Lab in Beijing,Beijing Key Lab for Cardiovascular Precision Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing 10029,China)
出处
《中国循证心血管医学杂志》
2019年第9期1099-1103,共5页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
北京市科学技术委员会资助(Z181100001918008)
