Razi Journal of Medical Sciences

fa بررسی عوارض زودرس و دیررس ترمیم جراحی ترانکوس آرتریوزوس در مرکز قلب و عروق شهید رجایی تهران Evaluation of Early and Late Complications of Truncus Arteriosus Surgical Repair in Shaheed Rajaie Cardiovascular, Medical & Research Center, Tehran قلب کودکان Pediatric Cardiology پژوهشي Research <div style="text-align: justify;">زمینه و هدف: ترانکوس آرتریوزوس نیاز به جراحی و ترمیم کامل پس از تشخیص در دوره جنینی یا بلافاصله پس از تولد دارد. هدف این مطالعه تعیین فراوانی عوارض زودرس و دیررس به دنبال ترمیم جراحی ترانکوس آرتریوزوس است. روش‌ کار: <a name="_Hlk166572598">در این مطالعه گزارش موارد، پرونده کلیه بیمارانی که در فاصله سالهای 1385 تا 1394 در مرکز قلب و عروق شهید رجایی تحت عمل جراحی برای درمان ترانکوس آرتریوزوس قرار گرفته بودند، بررسی شد. ویژگیهای دموگرافیک بیماران، سوابق بیماری، پیامدهای اولیه و داخل بیمارستانی، عوارض و مورتالیتی بعد از ترخیص و پیامدهای بلندمدت مورد ارزیابی قرار گرفت.</a> یافته‌ها: در کل پرونده 62 کودک 1 تا 36 ماهه بررسی شد. میانگین سنی کودکان 8/5 ماه بود. <a name="_Hlk166567236">84/54% </a>کودکان پسر و 16/45 % دختر بودند. آریتمی در 45/45% کودکان بعد از جراحی اول و بحران PH در 64/22% موارد مشاهده شد. بیشترین مورتالیتی مربوط به مرگومیر داخل بیمارستانی با 94/41% بود. تفاوت آماری معناداری در مورتالیتیهای داخل اتاق عمل، داخل بیمارستان و بلندمدت بین پسران و دختران و همچنین گروههای سنی مشاهده نشد. با پایین آمدن سن در جراحیهای انجام شده بعد از سال 1390 و کاهش وزن و قد، مورتالیتی افزایش پیدا کرده است. اختلاف معنیداری بین کودکان پسر و دختر و همچنین گروههای سنی در بروز عوارض جانبی مشاهده نشد. نتیجه گیری: با پایین آمدن سن در جراحیهای ترمیم ترانکوس آرتریوزوس و کاهش قد و وزن، مورتالیتی افزایش یافته و بنظر میرسد تا زمان انجام این مطالعه در انجام این جراحیها در سنین پایین تر نیاز به امکانات و مهارت بیشتری در زمینه مراقبت‌های حین و بعد جراحی بخصوص استقاده از نیتریک اکساید جهت کنترل فشارخون ریوی وجود داشته و همجنین پیشنهاد می شود مطالعه ای جهت بررسی نتایج بعد از سال 1394 و مقایسه نتایج دو مطالعه انجام شود. </div> <div style="text-align: justify;">Background & Aims: Truncus arteriosus is a rare congenital cardiovascular disease and is reported to occur in approximately 6 out of 100,000 births that requires surgery and complete repair after diagnosis in the fetal period or immediately after birth. Due to the rapid progression of pulmonary vascular occlusive disease, the need for early repair is emphasized. In children who come to the hospital later, surgery may be complicated or even prohibited due to high pulmonary vascular resistance. This condition has short-term and long-term consequences that can affect a person's health and well-being. Despite the fact that complete repair in the neonatal period is effective and has acceptable results, the need for re-interventions is unavoidable Multicenter studies have reported different results for early and late outcomes, risk factors for mortality, and reintervention. Early diagnosis, shorter duration of cardiopulmonary bypass, and the use of smaller diameter right ventricle to pulmonary artery (RV-PA) conduit are potentially modifiable factors that can lead to improved outcomes and reduce morbidity and mortality in these patients. In this study we aimed to determine the frequency of early and late complications following truncus arteriosus repair. Methods: In this case series study, the records of all patients who underwent truncus arteriosus surgical repair were reviewed. Demographic characteristics of patients, medical history, medical treatments, primary and in-hospital outcomes such as hospital mortality, preoperative mechanical ventilation, surgical technique, postoperative complications, length of hospitalization, complications and mortality after discharge, and long-term outcomes (delay complications, mortality, need for re-surgery and long-term survival of patients) were recorded and evaluated. Results: In total, the data of 62 children aged 1 to 36 months were examined. The mean age of the children was 5.8 months. 54.84% of the children were boys and 45.16% were girls. In terms of truncus type, the most cases were type one (83.87%) and type two (16.12%), and coronary artery abnormalities before surgery were observed in 23.3% of children. The most and least types of surgery used in this study were aorta homograft with 29.03% and gortex tube with 6.45%, respectively. Arrhythmia was observed in 45.45% of children after the first surgery and PH crisis was observed in 22.64% of cases. The need for second and third reintervention was 22%, and moderate and severe aortic valve insufficiency was reported in 25% of people. The highest mortality was related to in-hospital mortality with 41.94%. In general, there was no significant difference between the causes of hospital mortality in different surgical methods, but the highest mortality occurred in patients with heart failure who underwent valve procedure surgery. Statistically, there was no significant difference in the types of mortality (in the operating room, in the hospital, long-term) between boys and girls, as well as age groups. Mortality has increased with the decrease in age in the surgeries performed after 2013 and the decrease in weight and height. Patients with lower weight and shorter height had a higher hospital mortality rate. But the average time of cardiopulmonary bypass (CPB) had no effect on hospital mortality. There was no significant difference between male and female children as well as age groups in the occurrence of side effects. Also, preoperative truncal valve stenosis is significantly related to death and hospital stay. While preoperative truncal valve failure has no significant effect on hospital mortality. In addition, hospital mortality was not significantly different between different types of truncus (P=0.73). Conclusion: Our study showed that with the decrease in age in truncus arteriosus repair surgeries and the decrease in height and weight, mortality has increased and It seems that until this study is done, performing this surgery at younger ages requires more facilities and skills in the field of intra- and postoperative care, especially the use of NO to control pulmonary blood pressure, and it is suggested that a study be conducted to examine the results after 1394 and compare the results of two studies. </div> ترانکوس آرتریوزوس, بیماری‌های مادرزادی قلب, جراحی قلب Truncus Arteriosus, Congenital Heart Diseases, Heart Surgery 1 11 http://rjms.iums.ac.ir/browse.php?a_code=A-10-8240-1&slc_lang=fa&sid=1 Avisa Tabib آویسا طبیب 3900319475328460090164 3900319475328460090164 No Professor, Heart Valve Diseases Research Center, Shaheed Rajaie Cardiovascular Medical & Research Institute, Tehran, Iran استاد، مرکز تحقیقات بیماری‌های دریچه قلب، انستیتو قلب و عروق شهید رجایی، تهران، ایران Seyed Mohammad Mahdavi سیدمحمد مهدوی 3900319475328460090165 3900319475328460090165 No Professor, Congenital Cardiovascular Diseases Research Center, Shaheed Rajaie Cardiovascular Medical & Research Institute, Tehran, Iran استاد، مرکز تحقیقات بیماری‌های مادرزادی قلب و عروق، انستیتو قلب و عروق شهید رجایی، تهران، ایران Nader Givjaj نادر گیوتاج 3900319475328460090166 3900319475328460090166 No Professor, Cardiovascular Research Center, Shaheed Rajaie Cardiovascular Medical & Research Institute, Tehran, Iran استاد، مرکز تحقیقات قلب و عروق، انستیتو قلب و عروق شهید رجایی، تهران، ایران Golnar Mortaz Hejri گلنار مرتاض هجری gmortaz.h@gmail.com 3900319475328460090167 3900319475328460090167 Yes Assistant Professor, Cardiovascular Research Center, Shaheed Rajaie Cardiovascular Medical & Research Institute, Tehran, Iran استادیار، مرکز تحقیقات قلب و عروق، انستیتو قلب و عروق شهید رجایی، تهران، ایران Maryam Nikoufar مریم نیکوفر 3900319475328460090168 3900319475328460090168 No Assistant Professor, Pediatric Department, Ekbatan Children's Hospital, Hamadan University of Medical Sciences, Hamadan, Iran استادیار، گروه کودکان، بیمارستان کودکان اکباتان، دانشگاه علوم پزشکی همدان، همدان، ایران Aliakbar Shah-Mohammadi علی اکبر شاه محمدی 3900319475328460090169 3900319475328460090169 No Professor, Cardiovascular Research Center, Shaheed Rajaie Cardiovascular Medical & Research Institute, Tehran, Iran استاد، مرکز تحقیقات قلب و عروق، انستیتو قلب و عروق شهید رجایی، تهران، ایران