室间隔完整的肺动脉瓣闭锁患者早中期预后的预测因素:一项人群研究

作     者：Daubeney P.E.F. Delany D.J. 张步升 

作者机构：Daubeney Royal Brompton Hospital Sydney St London SW3 6NP United Kingdom 

出 版 物：《世界核心医学期刊文摘(心脏病学分册)》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2006年第3期

页      面：60-61页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：室间隔 室中隔 肺动脉瓣闭锁 人群研究 患者 预后 

摘      要：Objectives: Pulmonary atresia with intact ventricular septum is a form of congenital heart disease usually associated with right-heart hypoplasia, with considerable morphologic heterogeneity and often poor outlook. Ascertainment of risk factors for poor outcome is an important step if an improvement in outcome is to be achieved. Methods: The UK and Ireland Collaborative study of Pulmonary Atresia with Intact Ventricular Septum is an ongoing population-based study of all patients born with this disease from 1991 through 1995. All available clinical, morphologic, and investigative variables were directly reviewed, and risk factor analysis was performed for poor outcome. Results: One hundred eighty-three patients presented with pulmonary atresia with intact ventricular septum. Fifteen underwent no procedure, and all died. Of the remainder, 67 underwent a right ventricular outflow tract procedure(catheter or surgical), 18 underwent an outflow tract procedure with shunt, and 81 underwent a systemic-to-pulmonary shunt alone. One and 5-year survival was 70.8% and 63.8% , respectively. Results from Cox proportional hazards model analysis showed that low birth weight(P=.024), unipartite right ventricular morphology(P=.001), and the presence of a dilated right ventricle(P .001) were independent risk factors for death. The presence of coronary artery fistulae, right ventricular dependence, or the trcuspid valvar z score did not prove to be risk factors for death. After up to 9 years of follow-up, 29% have achieved a biventricular repair, 3% a so-called one-and-a-half ventricular repair, and 10.5% a univentricular repair, with 16.5% still having a mixed circulation(41% died). Conclusions: This population based study has shown which features at presentation place an infant in a high-risk group. This is important information for counseling in fetal life and for surgical strategy after birth.