Chimney reconstruction provides a wider subaortic space and reduces the risk of pulmonary artery compression in the Norwood-type aortic arch reconstruction without patch supplementation
Chimney reconstruction provides a wider subaortic space and reduces the risk of pulmonary artery compression in the Norwood-type aortic arch reconstruction without patch supplementation
复制标题
烟囱重建提供了更宽的主动脉下空间，并降低了诺伍德型主动脉弓重建中肺动脉受压的风险，无需补片补充
DOI：
10.1093/ejcts/ezab184
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发表时间：
2021
影响因子：
3.4
通讯作者：
Yaku Hitoshi
中科院分区：
文献类型：
--
作者：
Asada Satoshi;Yamagishi Masaaki;Maeda Yoshinobu;Itatani Keiichi;Fujita Shuhei;Hongu Hisayuki;Nakatsuji Hiroki;Yaku Hitoshi
新生主动脉压迫肺动脉是左心发育不良综合征行Norwood型姑息治疗后的严重并发症。过度的补片剪裁或自体组织的有限使用都可能导致主动脉下腔狭窄。烟囱技术理论上可以提供一个广泛的主动脉下space. METHODSTwen-nine患者与前和后NP计算机断层扫描数据提供的37例连续患者接受NP在我们的机构进行了审查。测量主动脉弓高度、宽度、主动脉窦直径、主动脉弓下面积和主动脉弓角度。这些患者根据新牙弓重建技术、烟囱重建技术（CR）或传统直接重建技术（DR）进行分类。NP时的中位年龄和体重分别为2.1个月和3.5 kg。22例患者既往接受过双侧PA捆扎术。NP期间，17例CR和12例DR。DR组中有4例患者发生PA压迫。两组均未发现新主动脉弓扩张。CR组NP后牙弓宽度、新牙弓下面积和牙弓角度均显著大于NP组。前NP弓高度显着较小的DR患者PA压缩比那些没有。CONCLUSION烟囱技术降低PA压缩的风险，并提供了一个更广泛的主动脉下空间和较小的急性弓角。该技术对新主动脉根部无短期影响。术前小的弓高是DR中PA压缩的潜在危险因素，烟囱技术可能是一种有效的解决方案。
OBJECTIVESPulmonary artery (PA) compression by the neoaorta is a serious complication after the Norwood-type palliation (NP) for hypoplastic left heart syndrome. Either excess patch tailoring or limited use of autologous tissue may cause narrowing of the subaortic space. The chimney technique could theoretically provide a wide subaortic space.METHODSTwenty-nine patients with both pre- and post-NP computed tomography data available of the 37 consecutive patients who underwent NP in our institution were reviewed. Arch height, arch width, sinus of Valsalva diameter, area under the neoaortic arch and arch angle were measured. These patients were divided according to the neo-arch reconstruction technique, chimney reconstruction technique (CR) or conventional direct reconstruction technique (DR).RESULTSMedian age and weight at NP were 2.1 months and 3.5 kg, respectively. Twenty-two patients underwent previous bilateral PA banding. During NP, 17 CR and 12 DR were performed. Four patients in the DR group developed PA compression. No neoaortic arch dilatation was found in either group. Post-NP arch width, area under the neo-arch and the arch angle were significantly larger in the CR group. Pre-NP arch height was significantly smaller in DR patients with PA compression than in those without.CONCLUSIONSThe chimney technique decreased the risk of PA compression and provided a wider subaortic space and a less acute arch angle. This technique had no short-term effect on the neoaortic root. Small preoperative arch height is a potential risk factor for PA compression in DR, and the chimney technique could be an effective solution.