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Circulation:儿童进行圆锥动脉干畸形修复术后要警惕室间隔缺损!

2015-08-08 崔倩 译 MedSci原创

壁内室间隔缺损(VSDs)通过右心室游离壁进行室内通信,可发生在修复圆锥动脉干畸形后。研究人员评估了残余的VSDs患病率及其对术后效果的影响。该研究的参与者是从2006年1月1日至2013年6月30日之间接受圆锥动脉干畸形双心室修复的孩子们,并且对其术后经胸超声心动图检查进行了分析。研究人员利用图像对室内和非室内VSDs进行了复查。主要终点是复合的死亡率,体外膜肺氧合(ECMO)的使用,以及对后续

壁内室间隔缺损(VSDs)通过右心室游离壁进行室内通信,可发生在修复圆锥动脉干畸形后。研究人员评估了残余的VSDs患病率及其对术后效果的影响。

该研究的参与者是从2006年1月1日至2013年6月30日之间接受圆锥动脉干畸形双心室修复的孩子们,并且对其术后经胸超声心动图检查进行了分析。研究人员利用图像对室内和非室内VSDs进行了复查。主要终点是复合的死亡率,体外膜肺氧合(ECMO)的使用,以及对后续的导管或手术VSD闭合的需要。次要结果是术后住院天数(PLOS)。残余VSD存在于442例患者中的256例患者(58%),其中231例(90%)大小<2毫米。49例(11%)有壁内VSD,207例(47%)有非壁内VSD。与非内部VSDs患者或残余VSD患者相比,室内VSDs患者更有可能到达主要复合终点(14/49[29%] vs 15/207[7%] vs 6/186[3%],P<0.0001)。此外,与非壁内VSDs患者或残余VSD患者相比,壁内VSDs患者有更长的PLOS(20天[IQR 11-42] vs 7天[5-14] vs 6天[4-11],P=0.0001)。在调整了已知的不良后果的危险因素,包括残余漏大小和手术后的复杂性后,这些联系依然显著。

在圆锥动脉干异常修复术后的残余VSDs患者中,壁内VSDs与术后并发症发生率、死亡率,以及更长PLOS唯一相关。因此在术后期间识别VSDs非常重要。

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