Subaortic Membrane and Aorto-Septal Angle: An Echocardiographic Assessment and Surgical Outcome
Subaortic Membrane and Aorto-Septal Angle: An Echocardiographic Assessment and Surgical Outcome
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DOI：
10.1177/2150135113485760
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发表时间：
2013-07-01
影响因子：
0.9
通讯作者：
Castaneda, Aldo R.
中科院分区：
文献类型：
--
作者：
Barboza, Laura A.;de Maria Garcia, Flor;Castaneda, Aldo R.
背景：主动脉下膜的发育尚未完全清楚。手术切除后的复发率仍然很高。我们试图评估室间隔角（AoSA）的差异，以可能解释左心室流出道内的改变，从而在主动脉下膜形成。方法：共113例接受主动脉瓣下膜切除术的患者与113例对照组在年龄和性别上相匹配。主动脉下膜切除组包括孤立的主动脉下膜（n = 34，组I），伴室间隔缺损（n = 29，组II）或动脉导管未闭（n = 50，组III）。结果如下：是说（+/-标准差）AoSA主动脉下膜组I、II和III之间无差异，但比对照组更陡（分别为126.2 +/- 9.2 vs 138.6 +/- 7.0、129.2 +/- 9.9 vs 137.7 +/- 10.0和126.2 +/- 8.1 vs 135 +/- 8.5;所有P <0.05）。此外，II组术前压差（28.8 ± 20.7 mm Hg）低于I组和III组（分别为67.0 ± 32.9和66.2 ± 33.1 mm Hg，P <0.001）。随访3 ~ 132个月。在22例（32%）患者中，主动脉下膜复发。术后早期残余压差和主动脉返流的发生与再次手术的需要相关（P <0.05）。结论：这些发现提示主动脉瓣下膜的形成与主动脉瓣下膜的形成有关。进一步的流变学实验是必要的。角度越陡复发的风险是否越高，可以通过更长的随访期来揭示。
Background: Development of a subaortic membrane is not fully understood. Recurrence after surgical removal continues to be high. We sought to assess the differences in aorto-septal angles (AoSA) to possibly explain alterations within the left ventricular outflow tract, hence in subaortic membrane formation. Methods: A total of 113 patients who underwent subaortic membrane resection were matched by age and sex with 113 controls. The subaortic membrane resection group included isolated subaortic membranes (n = 34, group I), associated with ventricular septal defect (n = 29, group II), or patent ductus arteriosus (n = 50, group III). Results: Mean ( +/- standard deviation) AoSA (in degrees) were not different between subaortic membrane groups I, II, and III but were steeper than their control groups (126.2 +/- 9.2 vs 138.6 +/- 7.0, 129.2 +/- 9.9 vs 137.7 +/- 10.0, and 126.2 +/- 8.1 vs 135 +/- 8.5, respectively; all Ps < .05). Additionally, group II had lower preoperative gradients (28.8 +/- 20.7 mm Hg) compared to groups I and III (67.0 +/- 32.9 and 66.2 +/- 33.1 mm Hg, respectively, P < .001). Follow-up ranged from 3 to 132 months. In 22 (32%) patients, a subaortic membrane recurred. Early postoperative residual gradients and development of aortic regurgutation were associated with the need for reoperation (P < .05). Conclusions: These findings suggest a contributing role of the AoSA in the development of subaortic membrane. Further rheological experiments are warranted. Whether the steeper the angle the higher the risk of recurrence may be revealed by longer follow-up periods.