背景:在完全房室管(CAVC)缺陷的婴儿中,术后左房室瓣反流(LAVVR)是已知的主要发病和死亡原因,也是再次手术的常见指征.然而,缺乏数据来确定不良结局的风险因素.我们的研究旨在发现预测出院和1年随访时LAVVR术后的超声心动图特征。
方法:回顾性队列研究在2013年至2022年期间在我院接受初始CAVC修复的患者,随访1年。排除患有主要合并症的患者。对连续超声心动图进行了审查。解剖细节,LAVVR的定量和定性测量,包括反流射流的数量,反流射流长度和静脉收缩宽度,并收集心室功能。测量的时间点包括术前经胸超声心动图(TTE),术后经食管超声心动图(PO-TEE),基于常规方案的术后第1天(POD1)TTE,出院TTE和术后1年(1yPO)TTE。配对t检验,卡方分析,并进行线性回归分析,将测量变量与LAVVR结局进行比较.
结果:纳入52例患者;92%患有21三体。大多数被归类为RastelliA(71%),其他拉斯泰利C(29%)。只有两名患者术前有中度或更高的LAVVR。修复时的平均年龄为125±44天。术前LAVVR是向后逐步回归后1年LAVVR严重程度的唯一重要预测因子。在PO-TEE上LAVVR<中度的人中,20%出院时恶化至≥中度,但只有9%的人在1年内保持这种状态。在PO-TEE上具有≥中度LAVVR的人中,40%提高到<中度1年。两名患者在1年内恶化,两者都是继发于可能的裂隙缝线开裂。由于缝线开裂,只有一名患者在严重的LAVVR继发于术后即刻需要再次手术。基于常规方案的POD1回声与改变的结果没有任何关联。
结论:术前LAVVR是1年时LAVVR严重程度的唯一显著预测因子。在PO-TEE中,≥中度LAVVR的患者的显着百分比(40%)在1年内改善至<中度。此外,基于常规方案的POD1回声与改变的结局没有任何关联.
BACKGROUND: In infants with complete atrioventricular canal (CAVC) defects, post-operative left atrioventricular valve regurgitation (LAVVR) is a known major cause of morbidity and mortality and a common indication for re-operation. However, there is scarce data to identify risk factors for poor outcomes. Our study aims to find echocardiographic characteristics that predict post-operative LAVVR at discharge and 1-year follow-up.
METHODS: Retrospective cohort study of patients with initial CAVC repair at our hospital who were followed for 1 year between 2013 and 2022. Patients with major co-morbid conditions were excluded. Serial echocardiograms were reviewed. Anatomic details, quantitative and qualitative measure of LAVVR including the number of regurgitant jets, regurgitant jet length and vena contracta width, and ventricular function were collected. The time points measured include pre-operative transthoracic echocardiogram (TTE), post-operative transesophageal echocardiogram (PO-TEE), routine protocol based post-operative day 1 (POD1) TTE, discharge TTE and 1-year post-operative (1yPO) TTE. Paired t-tests, chi-square analysis, and linear regression analysis were performed comparing measured variables to LAVVR outcomes.
RESULTS: Fifty-two patients were included; 92% had Trisomy 21. The majority were classified as Rastelli A (71%), others Rastelli C (29%). Only two patients had moderate or greater LAVVR pre-operatively. The mean age at repair was 125 ± 44 days. Pre-operative LAVVR was the only significant predictor of LAVVR severity at 1 year after backward stepwise regression. Of those with < moderate LAVVR on PO-TEE, 20% had worsening to ≥ moderate at discharge, but only 9% remained that way at 1 year. Of those with ≥ moderate LAVVR on PO-TEE, 40% improved to < moderate by 1 year. Two patients who worsened at 1 year, both secondary to likely cleft suture dehiscence. Only one patient required reoperation in the immediate post-operative period secondary to severe LAVVR due to suture dehiscence. Routine protocol-based POD1 echo did not have any association with altered outcomes.
CONCLUSIONS: Pre-operative LAVVR was the only significant predictor of LAVVR severity at 1 year. A significant percentage (40%) of patient with ≥ moderate LAVVR on PO-TEE improved to < moderate by 1 year. Furthermore, routine protocol-based POD1 echo did not have any association with altered outcomes.