先心病2009年治疗新进展——转载
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先心病2009年治疗新进展---转载，谢谢原作者
1. van den Berg et al. studied exercise performance, biventricular reserve, and N-terminal pro-B-type natriuretic peptide, and exercise performance in relation to right ventricular (RV) volume in patients following repair of tetralogy of Fallot (TOF) at less than 2 years of age. At mid-term follow-up, all parameters were well-preserved, and unrelated to RV volume (Int J Cardiol 2009;133:363-70). 河南省人民医院心血管外科王锋郑州市第七人民医院心外科杨斌
van den Berg等。研究年龄小于2岁接受法洛氏四联症矫治手术患儿的运动能力、双心室保存、N-末端B型利钠肽前体、与右心室关联的运动能力。中期随访中，全部参数保持完好，与右心室容量不无。(Int J Cardiol 2009;133:363-70).
2. Knauth et al. used cardiac magnetic resonance to predict clinical outcomes in patients with TOF, with a median time from clinical repair to evaluation of 21 years. Adverse outcomes, defined as death, sustained ventricular tachycardia (VT), and increase in New York Heart Association functional class to grade II or IV, occurred in 21% of patients. Severe RV dilation and right or left ventricular systolic dysfunction predicted major adverse events (Heart 2008;94:211-6).
Knauth等。从手术时间至评估时间平均21年中，利用心脏核磁共振技术来预测法洛氏四联症患者临床治疗结果。确定死亡、持续性室性心动过速、纽约心功能分级增加到II或IV级等负性结果发生率为21%。重度右心室扩张和左或右心室收缩功能不全提示主要负性事件。(Heart 2008;94:211-6).
3. In an additional study of pulmonary insufficiency after tetralogy repair, Harrild and colleagues compared patients with TOF and RV dilatation who had undergone pulmonary valve replacement, as compared with those who had not. No significant differences were seen in sudden death, VT, or a combined endpoint of sudden death/VT in patients who had undergone pulmonary valve replacement (Circulation 2009;119:445-51).
在关于法洛氏四联症矫治术后肺动脉瓣关闭不全的另一项研究中，Harrild和同事们比较了接受肺动脉瓣移植手术和未接受肺动脉瓣移植手术的法洛氏四联症合并右心室扩大的患者。接受肺动脉瓣移植的患者中，猝死、室性心动过速、猝死/室性心动过速联合终点未见显著差异。(Circulation 2009;119:445-51).
4. Shiraishi et al. studied the impact of the age at Fontan on exercise capacity, hemodynamics, and ventricular function in children with systemic left ventricles. VO2max, left ventricular ejection fraction, and cardiac index were all higher in patients undergoing Fontan at <3 years of age (Ann Thorac Surg 2009;87:555-61).
Shiraishi等。研究儿童Fontan手术年龄对运动能力、血流动力学和心室功能（左室型单心室）。3岁以下接受Fontan手术的患者中最大氧耗量、左心室射血分数、心脏指数都较高。(Ann Thorac Surg 2009;87:555-61).
5. The Nationwide Inpatient Sample was used by Karamlou and colleagues to determine surgical practice patterns for adults with congenital heart disease. In-hospital mortality was lower (1.87%) for adults operated on by pediatric heart surgeons, as compared with 4.84% for those operated on by nonpediatric heart surgeons (Circulation 2008;118:2345-52).
Karamlou和同事选择全国住院患者做样本，以确定患有先天性心脏病成人的手术模式。儿科心脏外科医师手术的成年人住院死亡率较低(1.87%)，相比较而言，非儿科心脏外科医师手术的住院死亡率为4.84%。(Circulation 2008;118:2345-52).
6. Vida et al. studied the optimal timing of patent ductus arteriosus ligation in premature infants. Medical treatment was successful in 149 of 201 patients. More than two cycles of ibuprofen were associated with increased risk for bronchopulmonary dysplasia and acute renal failure (Ann Thorac Surg 2009;87:1509-16).
研究早产儿动脉导管未闭结扎手术的最佳时机。201例中149例内科治疗成功。两个疗程以上的布洛芬可增加支气管肺发育不良和急性肾功能衰竭的风险。(Ann Thorac Surg 2009;87:1509-16).
7. Bov? et al. investigated 93 children following the arterial switch procedure for D-transposition of the great arteries (D-TGA). At a mean follow-up of 5 years, aortic regurgitation >2+ developed in 10% of patients with D-TGA with intact ventricular septum and 23% of patients with D-TGA and ventricular septal defect (VSD). Freedom from re-intervention at 1, 5, and 10 years was 98%, 96%, and 96% for D-TGA/intact VSD and 65%, 63%, and 63% for D-TGA/VSD (Ann Thorac Surg 2008;85:823-30).
Bov等。研究接受动脉调转手术的93例右型完全性大动脉转位(D-TGA)患儿。在平均5年随访期，室间隔完整型D-TGA中出现主动脉瓣返流（>2+）为10%，室间隔缺损型D-TGA中为23%。1、5、10年免于再次手术干预在室间隔完整型D-TGA中分别为98%,、96%和 96%，
在室间隔缺损型D-TGA中分别为65%,、63%和 63%。(Ann Thorac Surg 2008;85:823-30).
8. Because of a previous study implicating balloon atrial septostomy (BAS) as a cause of brain injury, Petit and colleagues reported on magnetic resonance imaging of patients prior to surgical repair of TGA. Of 26 patients, 14 underwent BAS. No strokes occurred, although 10 of 26 patients were found to have hypoxic brain injury in the form of periventricular leukomalacia. No association was seen between this finding and BAS. Infants with periventricular leukomalacia had lower preoperative oxygenation and longer time to surgery than infants without the finding (Circulation 2009;119:709-16).
由于先前的研究表明房间隔气囊造口术是导致脑损害的原因之一，Petit和同事们报道了完全性大动脉转位患者手术治疗之前的核磁共振影像学。26例患者中，14例接受房间隔气囊造口术。尽管26例中10例出现可引起脑室周围白质软化的缺氧脑损害，但是无脑中风出现。没有发现这个结果与房间隔气囊造口术有关。与不伴有脑室周围白质软化的婴儿相比，伴有脑室周围白质软化的婴儿术前吸氧治疗率较低，手术时间更长。(Circulation 2009;119:709-16).
9. Sharma et al. reported outcomes of children undergoing anatomic repairs for congenitally corrected TGA. A total of 31 patients underwent an atrial switch/Rastelli procedure with 17% early deaths and no late deaths. A total of 37 patients underwent a double switch with 13.5% early mortality and 10.8% late mortality. An additional four patients required re-operations, four had left ventricular ejection fraction <40%, five had moderate aortic regurgitation, and five patients had symptomatic tricuspid insufficiency, one with tricuspid stenosis, and one with superior vena cava obstruction (J Thorac Cardiovasc Surg 2009;137:404-12).
Sharma等。报道先天性矫正型完全性大动脉转位患儿接受解剖矫治的效果。总计31例患者接受心房switch/Rastelli手术，早期死亡率17%，无晚期死亡。总计37例患者接受动脉双调转手术，早期死亡率13.5%，晚期死亡率10.8%。另外有4例患者接受再次手术，4例左心室射血分数<40%，5例患者中度主动脉瓣反流，5例患者出现有症状的三尖瓣关闭不全，1例患者三尖瓣狭窄，1例患者上腔静脉梗阻。(J Thorac Cardiovasc Surg 2009;137:404-12).
10. Tabbutt et al. studied neurodevelopmental outcomes for 83 infants undergoing staged palliation for hypoplastic left heart syndrome at 1 year of age. The neuromuscular examination was abnormal or suspect in 65% of patients. The mean Mental Developmental Index score was 90, and 20 patients had scores <70. The mean Psychomotor Development Index was 74, with 42 patients having scores <70. In multivariate analysis, younger gestational age, presence of a genetic syndrome, and need for preoperative intubation had negative effects on neurodevelopmental outcomes. Operative factors, including duration of deep hypothermic circulatory arrest, were not shown to impact neurodevelopmental outcomes (Pediatrics 2008;121:476-83).
Tabbutt等。研究83例1岁左心发育不良综合症患儿接受分期手术的神经发育结果。65%的患者神经肌肉检查不正常或可疑。平均智力发育指数评分为90，20例患者低于70分。平均精神发育指数为74分，42例患者低于70分。通过多变量分析，年轻的妊娠年龄、存在基因病、术前需插管对神经发育有不利的影响。包括深低温停循环在内的手术因素未表明影响神经发育结果。(Pediatrics 2008;121:476-83).
van den Berg等。研究年龄小于2岁接受法洛氏四联症矫治手术患儿的运动能力、双心室保存、N-末端B型利钠肽前体、与右心室关联的运动能力。中期随访中，全部参数保持完好，与右心室容量不无。(Int J Cardiol 2009;133:363-70).
2. Knauth et al. used cardiac magnetic resonance to predict clinical outcomes in patients with TOF, with a median time from clinical repair to evaluation of 21 years. Adverse outcomes, defined as death, sustained ventricular tachycardia (VT), and increase in New York Heart Association functional class to grade II or IV, occurred in 21% of patients. Severe RV dilation and right or left ventricular systolic dysfunction predicted major adverse events (Heart 2008;94:211-6).
Knauth等。从手术时间至评估时间平均21年中，利用心脏核磁共振技术来预测法洛氏四联症患者临床治疗结果。确定死亡、持续性室性心动过速、纽约心功能分级增加到II或IV级等负性结果发生率为21%。重度右心室扩张和左或右心室收缩功能不全提示主要负性事件。(Heart 2008;94:211-6).
3. In an additional study of pulmonary insufficiency after tetralogy repair, Harrild and colleagues compared patients with TOF and RV dilatation who had undergone pulmonary valve replacement, as compared with those who had not. No significant differences were seen in sudden death, VT, or a combined endpoint of sudden death/VT in patients who had undergone pulmonary valve replacement (Circulation 2009;119:445-51).
在关于法洛氏四联症矫治术后肺动脉瓣关闭不全的另一项研究中，Harrild和同事们比较了接受肺动脉瓣移植手术和未接受肺动脉瓣移植手术的法洛氏四联症合并右心室扩大的患者。接受肺动脉瓣移植的患者中，猝死、室性心动过速、猝死/室性心动过速联合终点未见显著差异。(Circulation 2009;119:445-51).
4. Shiraishi et al. studied the impact of the age at Fontan on exercise capacity, hemodynamics, and ventricular function in children with systemic left ventricles. VO2max, left ventricular ejection fraction, and cardiac index were all higher in patients undergoing Fontan at <3 years of age (Ann Thorac Surg 2009;87:555-61).
Shiraishi等。研究儿童Fontan手术年龄对运动能力、血流动力学和心室功能（左室型单心室）。3岁以下接受Fontan手术的患者中最大氧耗量、左心室射血分数、心脏指数都较高。(Ann Thorac Surg 2009;87:555-61).
5. The Nationwide Inpatient Sample was used by Karamlou and colleagues to determine surgical practice patterns for adults with congenital heart disease. In-hospital mortality was lower (1.87%) for adults operated on by pediatric heart surgeons, as compared with 4.84% for those operated on by nonpediatric heart surgeons (Circulation 2008;118:2345-52).
Karamlou和同事选择全国住院患者做样本，以确定患有先天性心脏病成人的手术模式。儿科心脏外科医师手术的成年人住院死亡率较低(1.87%)，相比较而言，非儿科心脏外科医师手术的住院死亡率为4.84%。(Circulation 2008;118:2345-52).
6. Vida et al. studied the optimal timing of patent ductus arteriosus ligation in premature infants. Medical treatment was successful in 149 of 201 patients. More than two cycles of ibuprofen were associated with increased risk for bronchopulmonary dysplasia and acute renal failure (Ann Thorac Surg 2009;87:1509-16).
研究早产儿动脉导管未闭结扎手术的最佳时机。201例中149例内科治疗成功。两个疗程以上的布洛芬可增加支气管肺发育不良和急性肾功能衰竭的风险。(Ann Thorac Surg 2009;87:1509-16).
7. Bov? et al. investigated 93 children following the arterial switch procedure for D-transposition of the great arteries (D-TGA). At a mean follow-up of 5 years, aortic regurgitation >2+ developed in 10% of patients with D-TGA with intact ventricular septum and 23% of patients with D-TGA and ventricular septal defect (VSD). Freedom from re-intervention at 1, 5, and 10 years was 98%, 96%, and 96% for D-TGA/intact VSD and 65%, 63%, and 63% for D-TGA/VSD (Ann Thorac Surg 2008;85:823-30).
Bov等。研究接受动脉调转手术的93例右型完全性大动脉转位(D-TGA)患儿。在平均5年随访期，室间隔完整型D-TGA中出现主动脉瓣返流（>2+）为10%，室间隔缺损型D-TGA中为23%。1、5、10年免于再次手术干预在室间隔完整型D-TGA中分别为98%,、96%和 96%，
在室间隔缺损型D-TGA中分别为65%,、63%和 63%。(Ann Thorac Surg 2008;85:823-30).
8. Because of a previous study implicating balloon atrial septostomy (BAS) as a cause of brain injury, Petit and colleagues reported on magnetic resonance imaging of patients prior to surgical repair of TGA. Of 26 patients, 14 underwent BAS. No strokes occurred, although 10 of 26 patients were found to have hypoxic brain injury in the form of periventricular leukomalacia. No association was seen between this finding and BAS. Infants with periventricular leukomalacia had lower preoperative oxygenation and longer time to surgery than infants without the finding (Circulation 2009;119:709-16).
由于先前的研究表明房间隔气囊造口术是导致脑损害的原因之一，Petit和同事们报道了完全性大动脉转位患者手术治疗之前的核磁共振影像学。26例患者中，14例接受房间隔气囊造口术。尽管26例中10例出现可引起脑室周围白质软化的缺氧脑损害，但是无脑中风出现。没有发现这个结果与房间隔气囊造口术有关。与不伴有脑室周围白质软化的婴儿相比，伴有脑室周围白质软化的婴儿术前吸氧治疗率较低，手术时间更长。(Circulation 2009;119:709-16).
9. Sharma et al. reported outcomes of children undergoing anatomic repairs for congenitally corrected TGA. A total of 31 patients underwent an atrial switch/Rastelli procedure with 17% early deaths and no late deaths. A total of 37 patients underwent a double switch with 13.5% early mortality and 10.8% late mortality. An additional four patients required re-operations, four had left ventricular ejection fraction <40%, five had moderate aortic regurgitation, and five patients had symptomatic tricuspid insufficiency, one with tricuspid stenosis, and one with superior vena cava obstruction (J Thorac Cardiovasc Surg 2009;137:404-12).
Sharma等。报道先天性矫正型完全性大动脉转位患儿接受解剖矫治的效果。总计31例患者接受心房switch/Rastelli手术，早期死亡率17%，无晚期死亡。总计37例患者接受动脉双调转手术，早期死亡率13.5%，晚期死亡率10.8%。另外有4例患者接受再次手术，4例左心室射血分数<40%，5例患者中度主动脉瓣反流，5例患者出现有症状的三尖瓣关闭不全，1例患者三尖瓣狭窄，1例患者上腔静脉梗阻。(J Thorac Cardiovasc Surg 2009;137:404-12).
10. Tabbutt et al. studied neurodevelopmental outcomes for 83 infants undergoing staged palliation for hypoplastic left heart syndrome at 1 year of age. The neuromuscular examination was abnormal or suspect in 65% of patients. The mean Mental Developmental Index score was 90, and 20 patients had scores <70. The mean Psychomotor Development Index was 74, with 42 patients having scores <70. In multivariate analysis, younger gestational age, presence of a genetic syndrome, and need for preoperative intubation had negative effects on neurodevelopmental outcomes. Operative factors, including duration of deep hypothermic circulatory arrest, were not shown to impact neurodevelopmental outcomes (Pediatrics 2008;121:476-83).
Tabbutt等。研究83例1岁左心发育不良综合症患儿接受分期手术的神经发育结果。65%的患者神经肌肉检查不正常或可疑。平均智力发育指数评分为90，20例患者低于70分。平均精神发育指数为74分，42例患者低于70分。通过多变量分析，年轻的妊娠年龄、存在基因病、术前需插管对神经发育有不利的影响。包括深低温停循环在内的手术因素未表明影响神经发育结果。(Pediatrics 2008;121:476-83).
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