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Árangur skurðaðgerða við meðfæddri ósæðarþrengingu hjá börnum á Íslandi 1990-2006

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Authors
Sverrir I.Gunnarsson
Bjarni Torfason
Gunnlaugur Sigfússon
Hróðmar Helgason
Tómas Guðbjartsson
Útgáfudagur
2009-10-01

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Önnur málmynd
Surgery for coarctation of the aorta in Iceland 1990-2006
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Læknablaðið 2009, 95(10):647-53
Útdráttur
BACKGROUND AND AIMS: Coarctation of the aorta (CoA) is a congenital narrowing of the aorta, distal to the origin of the left subclavian artery. Treatment consists of surgical excision but balloon angioplasty is also a treatment option for selected patients. The aim of this study was to evaluate surgical outcome in children operated for CoA in Iceland. MATERIAL AND METHODS: All Icelandic children (<18 yrs.) operated for CoA in Iceland between 1990 and 2006. Patients operated abroad (n=17) or managed conservatively (n=12) were excluded. Mean follow up period was 8.5 +/- 4.3 years. RESULTS: Of 67 children diagnosed with CoA, 38 were operated on in Iceland (mean age 36 +/- 58 months, and 22 male and 16 female patients), 10 required immediate surgery for cardiac failure and eight were diagnosed incidentally. Extended end-to-end anastomosis was the most common procedure (n=31). Subclavian-flap aortoplasty was performed in seven patients. Average operation time was 134 min. and mean aortic closure time was 21 +/- 9 min. Hypertension (58%) and heart failure (11%) were the most common postoperative complications. Recoarctation developed 35 +/- 56 months after surgery in seven patients (18%) and was successfully treated with balloon angioplasty. There were no operative deaths and no patients developed paraplegia. One patient suffered an ischemic injury to the brachial plexus. Today all of the patients are alive, except for one patient that died four months after surgery from heart failure. CONCLUSION: Majority of Icelandic patients with CoA are operated on in Iceland with excellent outcome, both regarding short term complications and long term survival.
Tilgangur: Að kanna árangur skurðaðgerða við meðfæddri ósæðarþrengingu hér á landi. Efniviður og aðferðir: Afturskyggn rannsókn sem tekur til allra barna (<18 ára) sem gengust undir skurðaðgerð við meðfæddri ósæðarþrengingu á Íslandi frá 1990 til 2006. Börnum sem ekki gengust undir aðgerð (n=12) eða gengust undir skurðaðgerð erlendis (n=17) var sleppt. Niðurstöður: Af 67 börnum sem greindust á tímabilinu gengust 38 undir skurðaðgerð á Íslandi (meðalaldur 36 mánuðir, 22 drengir), þar af 10 undir bráðaaðgerð vegna hjartabilunar. Átta börn greindust án einkenna. Bein æðatenging var gerð hjá 31 barni og subclavianflap viðgerð hjá sjö þeirra. Aðgerðartími var að meðaltali 134 mínútur (bil 80-260) og tangartími á ósæð 21 mínúta. Miðgildi legutíma var níu dagar og algengustu fylgikvillar eftir aðgerð voru tímabundinn háþrýstingur (58%) og hjartabilun (11%). Endurþrenging greindist hjá sjö sjúklingum (18%), að meðaltali 35 mánuðum frá aðgerð og tókst í öllum tilfellum að meðhöndla hana með belgvíkkun. Öll börnin lifðu aðgerðina og útskrifuðust af sjúkrahúsi. Við eftirlit hafði eitt barn látist, en það lést fjórum mánuðum eftir aðgerð vegna hjartabilunar. Ályktun: Rúmlega helmingur barna með meðfædda ósæðarþrengingu gengst undir skurðaðgerð á Íslandi. Árangur þessara aðgerða er mjög góður hér á landi, bæði hvað varðar snemmkomna fylgikvilla og langtíma lífshorfur.
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