Causes of death after the modified Norwood procedure:: A study of 122 postmortem cases
Causes of death after the modified Norwood procedure:: A study of 122 postmortem cases
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DOI：
10.1016/s0003-4975(97)01041-2
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发表时间：
1997-12-01
影响因子：
4.6
通讯作者：
Van Praagh, R
中科院分区：
文献类型：
--
作者：
Bartram, U;Gr端nenfelder, J;Van Praagh, R
背景尽管改良的诺伍德手术作为左心发育不良综合征的姑息治疗的结果有了显着改善，但住院死亡率仍然很高（28%至46%）。方法。为了确定死亡原因并考虑其治疗应用，我们回顾了1980年至1995年（含）122例接受诺伍德手术后死亡的患者的病理学经验。最重要的死亡原因是冠状动脉灌注受损（33例患者，27%），肺血流量过多（23例患者，19%），肺动脉血流阻塞（21例患者，17%），新生主动脉阻塞（17例患者，14%），右心室衰竭（16例患者，13%），出血（9例患者，7%），感染（6例患者，5%），三尖瓣或常见房室瓣功能障碍（6例患者，5%），猝死假定心律失常（6例患者，5%）和坏死性小肠结肠炎（3例患者，3%）。在26例患者（21%）中，一个以上的因素似乎是导致死亡的原因。发现诺伍德手术后的主要死亡原因是与肺灌注（36%）、心肌灌注（27%）和全身器官灌注（14%）相关的手术技术问题。(C)1997年，美国胸外科医师协会（Society of Thoracic Surgeons）
Background. Although the results of the modified Norwood procedure as palliation for the hypoplastic left heart syndrome have improved considerably, in-hospital mortality remains high (28% to 46%).Methods. To establish the causes of death and consider their therapeutic applications, we reviewed our pathology experience from 1980 to 1995, inclusive, regarding 122 patients who died after undergoing the Norwood procedure.Results. The most important causes of death were found to be impairment of coronary perfusion (33 patients, 27%), excessive pulmonary blood flow (23 patients, 19%), obstruction of pulmonary arterial blood flow (21 patients, 17%), neoaortic obstruction (17 patients, 14%), right ventricular failure (16 patients, 13%), bleeding (9 patients, 7%), infection (6 patients, 5%), tricuspid or common atrioventricular valve dysfunction (6 patients, 5%), sudden death from presumed arrhythmias (6 patients, 5%), and necrotizing enterocolitis (3 patients, 3%). In 26 patients (21%), more than one factor appeared responsible for death.Conclusions. The leading causes of death after the Norwood procedure were found to be largely correctable surgical technical problems associated with perfusion of the lungs (36%), of the myocardium (27%), and of the systemic organs (14%). (C) 1997 by The Society of Thoracic Surgeons.