Aortico-left ventricular tunnel: 35-year experience
Aortico-left ventricular tunnel: 35-year experience
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DOI：
10.1016/j.jacc.2004.04.032
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发表时间：
2004-07-21
影响因子：
24
通讯作者：
Keane, JF
中科院分区：
文献类型：
--
作者：
Martins, JD;Sherwood, MC;Keane, JF
目的 本研究的目的是回顾我们 35 年的主动脉-左心室隧道 (ALVT) 经验，重点是诊断、手术细节和随访。 背景 主动脉-左心室隧道是一种罕见的先天性异常。由于对主动脉瓣反流 (AR) 的长期关注，我们提倡新生儿手术。 方法 我们从 1963 年到 2002 年 8 月确定了 11 名患者。对临床、超声心动图、导管插入术和手术细节进行了回顾。结果 11 名患者中，8 名在不到 6 个月大时就诊（6 名患有充血性心力衰竭），3 名后来出现杂音，所有患者均具有 AR 的临床证据。 45% 的患者存在相关病变，最常见的是主动脉瓣和冠状动脉异常。考虑了导管阻塞，但有 5 例没有进行。其中一项记录了自发闭塞。 10 例接受了手术（9 例在我们机构），7 例直接缝合，2 例通过 AVLT 主动脉端补片闭合。随访时（中位时间 5 年；1 个月至 35 年），所有患者均无症状； 3 例有残余 ALVT（1 例中度，2 例小/普通），最多有轻度 AR。 结论 主动脉-左心室隧道是一种罕见的心脏畸形，术后长期预后良好。 45%发生相关病变。导管插入术应保留用于无创性检查结果不明确或经导管封堵的患者。我们建议大多数患者进行手术。我们报告了一名患者的自发闭合，这促使我们考虑对罕见的小型无症状 AVLT 进行保守随访。 (C) 2004 年由美国心脏病学会基金会资助。
OBJECTIVES The purpose of this study was to review our 35 years of experience with aortico-left ventricular tunnel (ALVT), with emphasis on diagnosis, surgical details, and follow-up.BACKGROUND Aortico-left ventricular tunnel is a rare congenital anomaly. Neonatal surgery has been advocated in all due to long-term concern of valvar aortic regurgitation (AR).METHODS We identified 11 patients from 1963 to August 2002. Clinical, echocardiographic, catheterization, and surgical details were reviewed.RESULTS Eight of 11 patients presented at less than six months old (six with congestive heart failure) and three later with a murmur, all with clinical evidence of AR. Associated lesions, most commonly aortic valve and coronary artery anomalies, were present in 45%. Catheter occlusion was considered but not performed in five. Spontaneous occlusion was documented in one. Ten had surgery (nine in our institution), seven with direct suture and two by patch closure of the aortic end of the AVLT. At follow-up (median, 5 years; 1 month to 35 years), all were asymptomatic; three had residual ALVT (one moderate, two small/trivial), with at most mild AR.CONCLUSIONS Aortico-left ventricular tunnel is a rare cardiac malformation with a good post-operative long-term outcome. Associated lesions occurred in 45%. Catheterization should be reserved for patients with unclear non-invasive findings or transcatheter closure. We recommend surgery for most patients. We report spontaneous closure in one patient, prompting consideration of conservative follow-up in rare small, asymptomatic AVLT. (C) 2004 by the American College of Cardiology Foundation.