UNASSIGNED:维持足够的分支肺动脉生长对于防止动脉干修复后早期(<3年)右心室流出道再次手术至关重要。我们假设改良的动脉干修复将分支肺动脉保持在原位将促进分支肺动脉生长并限制早期右心室流出道再次手术。
未经批准:对于需要修复I型和II型动脉干的婴儿,通过曲棍球棒切口将躯干根部分开,使分支肺动脉保持在原位,室间隔缺损是闭合的,短主动脉移植用于重建右心室流出道。超声心动图测量术前和随访分支肺动脉直径。
未经评估:在1998年至2020年之间,使用改良方法修复了41名婴儿(I型,28;II型,13).中位随访时间为11.6(四分位数间距,3.1-15.5)年,术前左肺动脉和右肺动脉Z评分及其相应的随访测量值之间无明显变化(左肺动脉:0.97,四分位距,0.6-1.6vs左肺动脉:1.4,四分位数间距,-0.3至1.9)(右肺动脉:0.6,四分位数间距,-0.4至1.7vs.右肺动脉:0.3四分位数间距,0.5-0.9)。只有7.3%(n=2)的随访右肺动脉Z评分低于术前测量值2.5Z评分。四名儿童(9.8%)需要早期右心室流出道再次手术。在多变量分析中,较大的导管Z评分与较长的右心室流出道再手术时间相关(风险比,0.55,置信区间,0.307-0.984;P=0.043)。
未经授权:在初始动脉干修复时将分支肺动脉保持在原位允许分支肺动脉生长,限制早期右心室流出道再手术。
UNASSIGNED: Maintaining adequate branch pulmonary arterial growth is critical in preventing early (<3 years) right ventricular outflow tract reoperation after the repair of truncus arteriosus. We hypothesized that a modified truncus arteriosus repair keeping the branch pulmonary arteries in situ would promote branch pulmonary arterial growth and limit early right ventricular outflow tract reoperation.
UNASSIGNED: For infants requiring repair for type I and II truncus arteriosus, the truncal root was septated through a hockey stick incision keeping the branch pulmonary arteries in situ, the ventricular septal defect was closed, and a short aortic homograft was used to reconstruct the right ventricular outflow tract. Echocardiograms measured preoperative and follow-up branch pulmonary artery diameter.
UNASSIGNED: Between 1998 and 2020, 41 infants were repaired using the modified approach (type I, 28; type II, 13). With a median follow-up of 11.6 (interquartile range, 3.1-15.5) years, there was no significant change between preoperative left pulmonary artery and right pulmonary artery Z-scores and their corresponding follow-up measurement (left pulmonary artery: 0.97, interquartile range, 0.6-1.6 vs left pulmonary artery: 1.4, interquartile range, -0.3 to 1.9) (right pulmonary artery: 0.6, interquartile range, -0.4 to 1.7 vs right pulmonary artery: 0.3 interquartile range, 0.5-0.9). Only 7.3% (n = 2) of follow-up right pulmonary artery Z-scores were less than 2.5 Z-scores below preoperative measurements. Four children (9.8%) required early right ventricular outflow tract reoperation. On multivariable analysis, larger conduit Z-scores were associated with greater time to right ventricular outflow tract reoperation (hazard ratio, 0.55, confidence interval, 0.307-0.984; P = .043).
UNASSIGNED: Maintaining the branch pulmonary arteries in situ at initial truncus arteriosus repair allows for branch pulmonary arterial growth, limiting early right ventricular outflow tract reoperation.