目的 探讨儿童期冠状动脉(冠脉)异常起源于主动脉(anomalous aortic origin of coronary artery,AAOCA)的个体化外科治疗策略及预后情况.方法 回顾性分析2018年3月—2021年8月上海儿童医学中心心脏中心收治的AAOCA患儿的临床资料.结果 共纳入17例患儿,其中男13例、女4例,中位年龄88(44,138)个月,中位体重25(18,29)kg.全组患儿均接受手术治疗,冠脉处理方法包括:冠脉去顶术9例,冠脉移植术5例及冠脉开孔术3例.1例患儿因严重心功能不全(左心室射血分数15％)术后预防性应用机械辅助循环,辅助12d后顺利撤机.术后早期无死亡病例发生,平均ICU停留时间(4.3±3.0)d,总住院时间(14.4±6.1)d,出院后均接受规律抗凝治疗3个月.术后中位随访时间15(13,24)个月,所有患儿未再发生胸痛、晕厥等临床症状,心功能分级较术前明显改善,影像学检查显示术侧冠脉血流通畅,无再狭窄发生.结论 AAOCA易诱发心肌缺血甚至心源性猝死,一经诊断需尽快手术治疗;根据冠脉解剖特点采用个体化手术方式治疗AAOCA早期效果满意,中期随访患儿症状改善明显,心功能恢复良好.
Individualized surgical treatment strategy for children with anomalous aortic origin of coronary artery
Objective To summarize and explore the individualized surgical treatment strategy and prognosis of anomalous aortic origin of coronary artery(AAOCA).Methods The clinical data of children with AAOCA admitted to Shanghai Children's Medical Center from March 2018 to August 2021 were retrospectively analyzed.Results A total of 17 children were enrolled,including 13 males and 4 females,with a median age of 88(44,138)months and a median weight of 25(18,29)kg.All patients received operations.The methods of coronary artery management included coronary artery decapitation in 9 patients,coronary artery transplantation in 5 patients and coronary artery perforation in 3 patients.One patient with severe cardiac insufficiency(left ventricular ejection fraction 15％)received mechanical circulatory assistance after the operation for 12 days.No death occurred in the early postoperative period,the average ICU stay time was 4.3±3.0 d,and the total hospital stay was 14.4±6.1 d.All the children received regular anticoagulation therapy for 3 months after discharge.The median follow-up time was 15(13,24)months.All patients received regular anticoagulation therapy for 3 months after discharge.No clinical symptoms such as chest pain and syncope occurred again.The cardiac function grade was significantly improved compared with that before operation.Imaging examination showed that the coronary artery blood flow on the operation side was unobstructed,and no restenosis occurred.Conclusion AAOCA is easy to induce myocardial ischemia and even sudden cardiac death.Once diagnosed,operation should be carried out as soon as possible.According to the anatomic characteristics of coronary artery,the early effect of individualized surgery is satisfactory,and the symptoms of the children are significantly improved and the cardiac function recovers well in the mid-term follow-up.
Anomalous aortic origin of coronary arterymyocardial ischemiaindividualized surgical treatment strategy
万方数据
维普
