对患有严重主动脉瓣狭窄、二尖瓣严重返流和胎儿水肿的早产新生儿进行分期双心室修补术:病例报告。

Yuta Teguri, Takashi Kido, Koji Miwa, Tomomitsu Kanaya, Shigemitsu Iwai, Hisaaki Aoki, Sanae Tsumura
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引用次数: 0

摘要

背景:手术治疗重度主动脉瓣狭窄、二尖瓣反流和左心室功能障碍是一项重大的临床挑战。主动脉瓣狭窄缓解后,左心室功能能否恢复以支持全身循环是一个令人担忧的问题。在这种情况下,手术或球囊主动脉瓣切开术结合双侧肺动脉束扎术和心房隔膜切除术可以让左心室有时间适应,同时右心室通过动脉导管支持全身循环。我们描述了一例患有严重主动脉瓣狭窄、二尖瓣严重反流和胎儿水肿的早产新生儿,她在接受了双侧肺动脉束扎术、房间隔切除术、球囊主动脉瓣成形术和动脉导管支架植入术后,成功接受了分期双心室修补术:一名 29 岁女性在妊娠 25 周时因胎儿超声心动图检查发现主动脉瓣重度狭窄、左心室功能严重受损、二尖瓣严重反流和卵圆孔受限而转诊至我院。胎龄 33 周时,婴儿经剖宫产出生。新生儿立即开始输注前列腺素 E1,并接受了急诊双侧肺动脉束缚术和心房间隔切除术。第二天,进行了球囊主动脉瓣成形术。新生儿接受了支架植入术以打通动脉导管,并接受了多球囊主动脉瓣成形术。4 个月大时,他接受了双心室修补术,包括主动脉瓣成形术、房间隔缺损闭合术、双侧肺动脉清创术和动脉导管结扎术。一岁时,他接受了罗斯-康诺手术。术后六年,患者全身情况稳定,目前状况良好:结论:对于一名胎儿水肿、主动脉瓣严重狭窄并伴有严重二尖瓣反流和左心室功能障碍的早产新生儿,成功实现了分期双心室修补术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Staged biventricular repair in a premature neonate with critical aortic stenosis, severe mitral regurgitation, and fetal hydrops: a case report.

Background: The surgical management of critical aortic stenosis, mitral regurgitation, and left ventricular dysfunction is a significant clinical challenge. Whether left ventricular function will recover to support systemic circulation after the relief of aortic stenosis is a concern. In this setting, surgical or balloon aortic valvotomy combined with bilateral pulmonary artery banding and atrial septectomy may allow time for left ventricular adaptation, while the systemic circulation is supported by the right ventricle through the ductus arteriosus. We describe the case of a premature neonate with critical aortic stenosis, severe mitral regurgitation, and fetal hydrops who successfully underwent staged biventricular repair after bilateral pulmonary artery banding, atrial septectomy, balloon aortic valvuloplasty, and stent implantation for ductus arteriosus.

Case presentation: A 29-year-old female was referred to our hospital at 25 weeks of gestation with fetal echocardiography findings of critical aortic stenosis, severely impaired left ventricular function, severe mitral regurgitation, and restrictive foramen ovale. At 33 weeks of gestational age, the baby was born via cesarean delivery. Prostaglandin E1 infusion was immediately initiated, and the neonate underwent emergecy bilateral pulmonary artery banding and atrial septectomy. On the second day, a balloon aortic valvuloplasty was performed. The neonate underwent stent implantation to open the ductus arteriosus and multiple-balloon aortic valvuloplasty. At 4 months of age, he underwent biventricular repair consisting of surgical aortic valvuloplasty, atrial septal defect closure, bilateral pulmonary artery debanding, and ductus arteriosus ligation. At 1 year of age, he underwent the Ross -Konno procedure. Six years after the operation, the patient's general condition was stable, and the patient is doing well.

Conclusions: Staged biventricular repair was successfully achieved in a premature neonate with fetal hydrops and critical aortic stenosis associated with severe mitral valve regurgitation and left ventricular dysfunction.

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