IS LUNG-BIOPSY USEFUL FOR SURGICAL DECISION-MAKING IN CONGENITAL HEART-DISEASE

被引：15

作者：

FRESCURA, C ^{[1
]}

THIENE, G ^{[1
]}

GAGLIARDI, MG ^{[1
]}

MAZZUCCO, A ^{[1
]}

PELLEGRINO, PA ^{[1
]}

DALIENTO, L ^{[1
]}

BISCAGLIA, S ^{[1
]}

CARMINATI, M ^{[1
]}

GALLUCCI, V ^{[1
]}

机构：

[1] UNIV PADUA,DEPT PATHOL,I-35100 PADUA,ITALY

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1991年 / 5卷 / 03期

关键词：

CARDIAC SURGERY; CONGENITAL HEART DISEASE; LUNG BIOPSY; PEDIATRIC CARDIOLOGY; PULMONARY VASCULAR DISEASE;

D O I：

10.1016/1010-7940(91)90209-3

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Sixty patients with congenital heart disease (CHD), age range 3 months - 45 years (median 2 years), underwent lung biopsy to exclude pulmonary vascular disease (PVD): 25 had an atrioventricular (AV) septal defect, 14 a ventricular septal defect (VSD), 7 a complete transposition of the great arteries (TGA) + VSD, 3 an atrial septal defect, and 2 a patent ductus arteriosus; 9 had other malformations. Scoring of histological section (0-4) according to a modified Heath-Edwards classification disclosed that 30 patients had severe "irreversible" PVD (greater-than-or-equal-to grade 3) (11 AV septal defect, 8 VSD, 6 TGA + VSD and 5 others); 8 patients were younger than 1 year. Pulmonary vascular resistance (PVR) was calculated in 51 patients and exceeded 7 U/m2 in 1 of 2 patients with grade 0, in 9 of 18 with grade 1, in 1 of 4 with grade 2, in 11 of 18 with grade 3, and in 8 of 9 with grade 4. PVR was also calculated after 100% oxygen administration in 19 patients, 14 of whom had a resting PVR greater-than-or-equal-to 7 U/m2. PVR persisted greater-than-or-equal-to 7 U/m2 in 5 patients: 4 had PVD greater-than-or-equal-to grade 3 and died after surgery. PVR fell to under 7 U/m2 in 14 patients, 3 of whom had PVD greater-than-or-equal-to grade 3: 1 patient with grade 4 was not operated upon and 2 with grade 3 were operated upon: all are alive. Follow-up in discharged living patients was 100%, with a mean of 50 months. Fifty-five patients underwent surgery with 10 early and 2 late deaths. Among the 12 subjects with a fatal outcome, 10 had irreversible lesions. The 5 non-operated patients all had irreversible lesions at biopsy, and are still alive. Among the 19 patients in grade 3, 16 were operated upon and 3 were not, with 5 (31%) and 0 deaths, respectively, while among the 11 patients in grade 4, 9 were operated upon and 2 were not, with 5 (55%) and 0 deaths, respectively. In conclusion, correlation of lung biopsy findings with haemodynamic data is crucial for surgical decision making in CHD. Grade 4 in itself, and grade 3 with a persistent high PVR (greater-than-or-equal-to 7 U/m2), even after oxygen administration, constitute a very high surgical risk; such patients should be left unrepaired until progressive deterioration warrants cardiopulmonary transplantation.

引用

页码：118 / 123

页数：6

共 15 条

[1]

Allen H.D., Erson R.C., Noren G.R., Moller J.H., Postoperative follow-up of patients with ventricular septal defect, Circulation, 50, pp. 465-471, (1974)

[2]

Anderson R.H., Levy A.M., Naeye R.L., Tabakin B.S., Rapidly progressing pulmonary vascular obstructive disease. Association with ventricular septal defects during early childhood, Am J Cardiol, 19, pp. 854-860, (1967)

[3]

Braunlin E.A., Moller J.H., Patton C., Lucas R.V., Lillehei W., Edwards J.E., Predictive value of lungs biopsy in ventricular septal defect: Long-term follow-up, JACC, 8, pp. 1113-1118, (1986)

[4]

Frescura C., Thiene G., Franceschini E., Talenti E., Mazzucco A., Pulmonary vascular disease in infants with complete atrioventricular septal defect, Int J Cardiol, 15, pp. 91-100, (1987)

[5]

Haworth S.G., Reid L., A morphometric study of regional variation in lung structure in infants with pulmonary hypertension and congenital cardiac defect: A justification of lung biopsy, Br Heart J, 40, pp. 823-831, (1974)

[6]

Haworth S.G., Pulmonary vasculature, Churchill Livingstone, Edinburgh, 1, pp. 123-157, (1987)

[7]

Heath D., Edwards J.E., Pathology of hypertensive vascular disease: A description of six grades of structural changes in the pulmonary arteries with special reference to congenital cardiac septal defects, Circulation, 43, pp. 533-547, (1958)

[8]

Neutze J.M., Ishikawa T., Clarkson P.M., Calder A.L., Barratboyes B.G., Kerr A.R., Assessment and follow-up of patients with ventricular septal defect and elevated pulmonary vascular resistance, Am J Cardiol, 63, pp. 327-331, (1989)

[9]

Rabinovitch M., Haworth S.G., Castaneda A.R., Nadas A.S., Reid L.M., Lung biopsy in congenital heart disease: A morphometric approach to pulmonary vascular disease, Circulation, 58, pp. 1107-1122, (1978)

[10]

Rabinovitch M., Castaneda A.R., Reid L., Lung biopsy with frozen section as a diagnostic aid in patients with congenital heart defects, Am J Cardiol, 47, pp. 77-84, (1981)

← 1 2 →