Abstract

 

OBJECTIVES

Aortic valve stenosis in neonates and infants is associated with congestive cardiac failure, and balloon or surgical valvuloplasty provides relief of stenosis. Occasionally severe aortic insufficiency necessitates urgent aortic valve replacement. We reviewed our experience with the Ross–Konno procedure in patients <1 year.

METHODS

Between October 2013 and May 2020, 36 patients underwent balloon (34) or surgical (2) aortic valvuloplasty for aortic stenosis. Six patients subsequently underwent a Ross–Konno procedure. The median age at operation was 55 (27–116) days and weight was 4.25 (2.5–12) kg. All patients were in severe cardiac failure and had a small aortic annulus with Z-score −3.1 (−1 to −4.4).

RESULTS

There were no early or late deaths. At the latest follow-up at 39 (13–60) months, ventricular function had improved in all patients and no patient was on anti-failure medication. On echocardiography, there wasno more than trivial aortic regurgitation and no left ventricular outflow tract obstruction. One patient required right ventricle to pulmonary artery conduit replacement and one patient had homograft stenting.

CONCLUSIONS

Despite the severe preoperative haemodynamic compromise, the urgent Ross–Konno procedure was associated with excellent operative survival and recovery of ventricular function. The need for reintervention to the pulmonary conduit remains a cause for concern.

中文翻译：

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严重主动脉瓣狭窄治疗后严重主动脉瓣功能不全的新生儿和婴儿的 Ross-Konno 手术

摘要

 

目标

新生儿和婴儿的主动脉瓣狭窄与充血性心力衰竭有关，球囊或外科瓣膜成形术可缓解狭窄。偶尔严重的主动脉瓣关闭不全需要紧急更换主动脉瓣。我们回顾了我们在小于 1 岁的患者中使用 Ross-Konno 手术的经验。

方法

2013 年 10 月至 2020 年 5 月期间，36 名患者接受了球囊 (34) 或手术 (2) 主动脉瓣成形术治疗主动脉瓣狭窄。六名患者随后接受了 Ross-Konno 手术。手术年龄中位数为 55（27-116）天，体重为 4.25（2.5-12）公斤。所有患者均出现严重心力衰竭，主动脉瓣环较小，Z评分为 -3.1（-1 至 -4.4）。

结果

没有早期或晚期死亡。在 39 (13-60) 个月的最近一次随访中，所有患者的心室功能都有所改善，并且没有患者使用抗心衰药物。在超声心动图上，只有轻微的主动脉瓣关闭不全，没有左心室流出道梗阻。一名患者需要更换右心室至肺动脉导管，一名患者接受了同种移植支架。

结论

尽管术前血流动力学严重受损，但紧急的 Ross-Konno 手术与出色的手术存活率和心室功能恢复相关。重新介入肺导管的需要仍然令人担忧。