CAJ | 학술논문

目的比较应用Danielson成形术与Danielson加人工瓣环矫治Ebstein心脏畸形的效果,以确定后者在治疗Ebstein心脏畸形中的作用.方法 2006年1月1日至2009年12月31日,31例10岁以上的青少年及成年A或B型Ebstein心脏畸形患者中19例采用单纯Danielson成形术矫治(A组),12例采用Danielson成形术加人工瓣环矫治(B组),回顾分析两组临床资料及治疗效果.结果围术期A组死亡1例(1/19例),B组无死亡,组间差异无统计学意义(P=0.510).所有术后生存患者随访5～41个月,平均(23.0±18.5)个月.A组术后1年1例因中重度三尖瓣关闭不全再次行三尖瓣成形术后死亡；B组术后无晚期死亡,组间远期病死率差异无统计学意义(P =0.724).超声复查显示患者房化心室均消失；三尖瓣反流结果,A组轻度11例,中到重度7例,B组轻度2例,无中到重度,组间差异显著(P=0.026).心功能NYHA A组Ⅰ级11例,Ⅱ～Ⅲ级7例；B组均为Ⅰ级,P=0.024.随访期内B组的6 min步行距离(6MWD)显著优于A组[(415±41)m对(382±46)m,P=0.047].结论 Danielson成形术加用人工瓣环矫治有助于提高A或B型Ebstein心脏畸形患者的中、远期疗效.
목적 비교응용Danielson성형술여Danielson가인공판배교치Ebstein심장기형적효과,이학정후자재치료Ebstein심장기형중적작용.방법 2006년1월1일지2009년12월31일,31례10세이상적청소년급성년A혹B형Ebstein심장기형환자중19례채용단순Danielson성형술교치(A조),12례채용Danielson성형술가인공판배교치(B조),회고분석량조림상자료급치료효과.결과 위술기A조사망1례(1/19례),B조무사망,조간차이무통계학의의(P=0.510).소유술후생존환자수방5～41개월,평균(23.0±18.5)개월.A조술후1년1례인중중도삼첨판관폐불전재차행삼첨판성형술후사망；B조술후무만기사망,조간원기병사솔차이무통계학의의(P =0.724).초성복사현시환자방화심실균소실；삼첨판반류결과,A조경도11례,중도중도7례,B조경도2례,무중도중도,조간차이현저(P=0.026).심공능NYHA A조Ⅰ급11례,Ⅱ～Ⅲ급7례；B조균위Ⅰ급,P=0.024.수방기내B조적6 min보행거리(6MWD)현저우우A조[(415±41)m대(382±46)m,P=0.047].결론 Danielson성형술가용인공판배교치유조우제고A혹B형Ebstein심장기형환자적중、원기료효.
Objective To compare the results of Danielson procedure with and without prosthetic valve ring in treating Ebstein anomaly and to define the effect of prosthetic valve ring on the procedure.Methods From January 2006 to December 2009,31 cases of Ebstein anomaly over 10 years old were classified as type A or type B according the Carpentier＇s classification scheme.Patients were treated by Danielson procedure or Danielson procedure plus prosthetic valve ring at Anzhen hospital.They were retrospectively classified as Danielson procedure group (group A,n =19) and Danielson procedure plus prosthetic valve ring group (group B,n =12 ).Results There was 1 early in-hospital death due to lung infection and hypoxemia in group A,and no early death in group B ( Fisher exact test,P =0.51 ).The mean follow-up time was ( 23.0 ± 18.5 ) months (5 -41 months).The cumulative follow-up time was 59.42 patient-years.There was one late death in group A due to the redo tricuspid valve plastic procedure because of severe tricuspid regurgitation,and no late death in group B.With echocardiography inspection,11 patients had mild and 7 had moderate to severe tricuspid regurgitation in group A,and only 2 mild tricuspid regurgitation in group B.The tricuspid valve competence after surgery in group B was better than in group A ( Fisher exact test,P=0.024).The 6-minute walk distance test (6MWD) in group B was significantly better than in group A(415 ±41 )m vs ( 382 ± 46 ) m( t test,P =0.047 ).The New York heart functional class in group B was statistically better than in Group A ( P =0.024).Conclusion Although there was no significant difference in the early and late mortality rate between the two groups after surgery,Danielson procedure plus prosthetic valve ring was better than pure Danielson procedure in prevention of late tricuspid regurgitation recurrence,heart function and 6MWD test during follow-up.