上海交通大学学报（医学版）

上海交通大学学报（医学版） >

2025 , Vol. 45 >Issue 6: 753 - 759

DOI: https://doi.org/10.3969/j.issn.1674-8115.2025.06.010

论著 · 临床研究

主动脉缩窄端侧吻合纠治术后的神经系统预后分析

  • 李卓杭 ,
  • 于新迪 ,
  • 任婧雅 ,
  • 沈佳 ,
  • 董素贞 ,
  • 王伟
展开
  • 1.上海交通大学医学院附属上海儿童医学中心心胸外科，上海 200127
    2.上海交通大学医学院附属上海儿童医学中心放射科，上海 200127
李卓杭（2000—），男，硕士生；电子信箱：sss.sss@sjtu.edu.cn。
第一联系人：王伟负责研究设计，于新迪、任婧雅、沈佳、董素贞参与患者入组和数据收集，李卓杭负责统计分析及论文撰写。所有作者均阅读并同意了最终稿件的提交。
王 伟，主任医师，博士；电子信箱：wangwei@scmc.com.cn。

收稿日期: 2024-10-10

  录用日期: 2025-03-07

  网络出版日期: 2025-06-28

基金资助

上海申康医院发展中心技术规范化管理和推广项目(SHDC22023228)

收起

Postoperative neurodevelopmental outcomes of end-to-side anastomosis for coarctation of the aorta

  • LI Zhuohang ,
  • YU Xindi ,
  • REN Jingya ,
  • SHEN Jia ,
  • DONG Suzhen ,
  • WANG Wei
Expand
  • 1.Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
    2.Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
First author contact:The study was designed by WANG Wei. YU Xindi, REN Jingya, SHEN Jia and DONG Suzhen contributed to patient enrolment and data collection. LI Zhuohang was responsible for statistical analysis and paper writing. All authors have read the final version of paper and consented to submission.
WANG Wei，E-mail:wangwei@scmc.com.cn.

Received date: 2024-10-10

  Accepted date: 2025-03-07

  Online published: 2025-06-28

Supported by

Foundation of Shanghai Hospital Development Center(SHDC22023228)

Fold

摘要

目的·分析主动脉缩窄（coarctation of the aorta，CoA）端侧吻合纠治术后患儿的神经系统预后。方法·收集2017年1月1日至2021年12月31日于上海交通大学医学院附属上海儿童医学中心行CoA端侧吻合纠治术患儿的手术及神经系统随访资料，包括磁共振成像（magnetic resonance imaging，MRI）和Griffiths精神发育量表评分。根据Griffiths精神发育量表的分量表评分，评估患儿神经系统各方面预后情况。通过比较MRI和Griffiths精神发育量表评分结果正常与异常患儿的临床资料，分析2种检查结果之间的相关性，以及检查结果与患儿是否实施体外循环（cardiopulmonary bypass，CPB）及CPB方式的相关性。结果·纳入单纯或合并简单心内畸形的CoA患儿27例。有MRI检查结果者25例，其中检查结果异常者5例（20.0%）；有Griffiths精神发育量表评分者26例，其中评分异常的患儿21例（80.77%），包括听力-语言评分异常18例、表现评分异常12例。MRI和Griffiths精神发育量表检查结果异常与是否实施CPB无相关性（P=0.341，P=1.000）。MRI检查结果和Griffiths精神发育量表评分显示，在接受CPB的病例中，中低温组神经系统预后无异常的患儿占所有无异常者的比例较高，分别为80.00%与100.00%。结论·CoA端侧吻合纠治术后患儿发生神经系统异常的比例较高，其中影响较大的是听力-语言和表现能力；CPB不是直接引起神经系统预后不良的危险因素，在中低温下实施可能有利于保护神经系统。

关键词： 主动脉缩窄; 磁共振成像; 体外循环; 神经系统预后; Griffiths精神发育量表

本文引用格式

李卓杭 , 于新迪 , 任婧雅 , 沈佳 , 董素贞 , 王伟 . 主动脉缩窄端侧吻合纠治术后的神经系统预后分析[J]. 上海交通大学学报（医学版）, 2025 , 45(6) : 753 -759 . DOI: 10.3969/j.issn.1674-8115.2025.06.010

Abstract

Objective ·To analyze the neurodevelopmental outcomes of children after end-to-side anastomosis for coarctation of the aorta (CoA). Methods ·The surgical and neurological follow-up data were collected from children who underwent end-to-side anastomosis for CoA at Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine from January 1, 2017 to December 31, 2021. Neurological assessments included magnetic resonance imaging (MRI) and Griffiths Mental Development Scale assessments. Neurodevelopmental outcomes were evaluated using Griffiths Mental Development Scale. Clinical characteristics were compared between patients with normal and abnormal MRI and Griffiths Mental Development Scale results to assess the correlation between the two assessments and their association with cardiopulmonary bypass (CPB) use and CPB modality. Results ·Twenty-seven children with isolated CoA or CoA combined with simple intracardiac anomalies were included. MRI results were available for 25 cases, with 5 showing abnormalities (20.0%). Griffiths Mental Development Scale results were available for 26 cases, with 21 (80.77%) showing abnormal scores, including 18 in hearing and language, and 12 in performance. No significant correlation was found between abnormal MRI or Griffiths Mental Development Scale results and the use of CPB (P=0.341, P=1.000). Among patients who underwent CPB, those in the moderate hypothermia group accounted for the majority of cases without neurological abnormalities, with proportions of 80.00% (MRI) and 100.00% (Griffiths Mental Development Scale). Conclusion ·Children undergone end-to-side anastomosis for CoA are at relatively high risk for neurodevelopmental abnormalities, particularly in hearing-language and performance domains. CPB may not be a direct risk factor for poor neurodevelopmental outcome, and moderate hypothermia during CPB may be neuroprotective.

Key words： coarctation of the aorta (CoA); magnetic resonance imaging (MRI); cardiopulmonary bypass (CPB); neurodevelopmental outcome; Griffiths Mental Development Scale

参考文献

[1] BAUMGARTNER H, BONHOEFFER P, de GROOT N M, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010)[J]. Eur Heart J, 2010, 31(23): 2915-2957.
[2] BROWN M L, BURKHART H M, CONNOLLY H M, et al. Coarctation of the aorta lifelong surveillance is mandatory following surgical repair[J]. J Am Coll Cardiol, 2013, 62(11): 1020-1025.
[3] DIJKEMA E J, LEINER T, GROTENHUIS H B. Diagnosis, imaging and clinical management of aortic coarctation[J]. Heart, 2017, 103(15): 1148-1155.
[4] LATAL B. Neurodevelopmental outcomes of the child with congenital heart disease[J]. Clin Perinatol, 2016, 43(1): 173-185.
[5] ROMEO D M, RICCI M, MIRRA F, et al. Longitudinal cognitive assessment in low-risk very preterm infants[J]. Medicina (Kaunas), 2022, 58(1): 133.
[6] MARINO B S, LIPKIN P H, NEWBURGER J W, et al. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association[J]. Circulation, 2012, 126(9):1143-1172.
[7] MAHLE W T, CLANCY R R, MOSS E M, et al. Neurodevelopmental outcome and lifestyle assessment in school-aged and adolescent children with hypoplastic left heart syndrome[J]. Pediatrics, 2000, 105(5): 1082-1089.
[8] BELLINGER D C, WYPIJ D, KUBAN K C, et al. Developmental and neurological status of children at 4 years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass[J]. Circulation, 1999, 100(5): 526-532.
[9] DIJKHUIZEN E I, de MUNCK S, de JONGE R C J, et al. Early brain magnetic resonance imaging findings and neurodevelopmental outcome in children with congenital heart disease: a systematic review[J]. Dev Med Child Neurol, 2023, 65(12): 1557-1572.
[10] KWAK J G, KIM W H, KIM J T, et al. Changes of brain magnetic resonance imaging findings after congenital aortic arch anomaly repair using regional cerebral perfusion in neonates and young infants[J]. Ann Thorac Surg, 2010, 90(6): 1996-2000.
[11] SIMON B V, SWARTZ M F, ORIE J M, et al. Neurodevelopmental delay after the neonatal repair of coarctation and arch obstruction[J]. Ann Thorac Surg, 2019, 108(5): 1416-1422.
[12] MAJNEMER A, LIMPEROPOULOS C, SHEVELL M, et al. Long-term neuromotor outcome at school entry of infants with congenital heart defects requiring open-heart surgery[J]. J Pediatr, 2006, 148(1): 72-77.
[13] 中华医学会小儿外科学分会心胸外科学组. 新生儿危重先天性心脏病术前评估中国专家共识(草案)[J]. 中华小儿外科杂志, 2017, 38(3): 164-169.
  The Subspecialty Group of Cardiothoracic Surgery, the Society of Pediatric Surgery, Chinese Medical Association. China expert consensus in preoperative assessment of newborn with critical congenital heart disease (draft)[J]. Chinese Journal of Pediatric Surgery, 2017, 38(3):164-169.
[14] CHETAN D, MERTENS L L. Challenges in diagnosis and management of coarctation of the aorta[J]. Curr Opin Cardiol, 2022, 37(1): 115-122.
Options
文章导航

/

〈 〉