SURGICAL METHODS OF TREATMENT INFANTS WITH CRITICAL AORTIC STENOSIS
About the author:
Imanov E., Truba Y. P., Plyska O. I., Dzuriy I. V., Lazoryshynets V. V.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
Aortic stenosis (constriction of aortic wit decrease square mouth of aortic) – this are group congenital heart disease, defiant violation blood with of left ventricule (LV). Critical aortic stenosis complicated pathology in infants, what requires the provision easy help. Treanment such patients are complex and dificult problem’s. Surgical methods of treatment include ballon alvuloplasty and open surgical. The purpose of our work is to analyze the own experience surgical treatment and ballon alvuloplasty critical aortic stenosis in infants. Objeсt and methods of research. Between 2007 and 2018, 58 patients with critical aortic stenosis were treated in National Amosov Institute of Cardiovascular Surgery. The patients were divide on two group. Group 1-st included 47 (81%) patients who accepted ballon valvuloplasty of aortic stenosis, 11 (19%) of patients (II-st group) done surgical treatment. The average age of I- group made up 20±14,3 days (from 2 to 60 days), the average masse of body – 3,4±1,5 kg (from 2,5 to 7 kg). In ІІ group the average age of patients made up 125±72,4 days (from 28 to 320 days), average masse made up 5,8±1,4 kg (from 3,5 to 8,7 kg). In 23 (39,5%) of patients both groups vice was diagnosed prenatally and confirm with help echocardiography right away to be born. This allowed urgently deliver to clinic for granted highly qualified chirurgical help. To operation gradient on aortic valve in patient I-st group by date EchoKG made up 67,6±19 мм Hg (from 30 to 114 мм Hg), in ІІ-st group – 69±23 мм Hg (from 29 to 120 мм Hg). Research results and their discussion. In І-st group hospital mortality made up 6,8% (n=4). In 2-st (4,5%) of patients postoperative period complicated two-way pneumonia, sepsis, and patients to dead on 15-th and 20-th day after procedure from increase respiratory and multiorgan failure. After ballon valvuloplasty noted significant decrease of gradient on aortic valvule in patients of I group and increase ejection fraction of ventricular sinister. But at mid-distance monitoring gradient of pressure on aortic valvule in most patients increased and beginnings aortic failure. Lethal cases in II-st group did not have. Time artificial circulation of lungs in average after dilatation an І-st group made up 31±12 hours (from 5 to 298 hours), in ІІ-st group – 38±16 hours (from 8 to 330 hours) (Р<0,05). The time to stay in ranimation in I-st group made up 3 days (from 2 to 40 days), in ІІ-st group – 5 days (from 3 to 60 days) (p<0,05). For date EcoKG, wich made in plane order for 24 hours with moment operation, note reliable decrease gradient as in І-st group with 65,2+2,7 to 30,3+3 мм Hg (P<0,05), so in ІІ-st group with 79,1+5,5 to 32,73+3,18 мм Hg (P<0,05). Significant increase ejection fraction (EF) LV note in of patients І-st group in which about hospitalization EF LV made up 48,21+3,1% (from 18 to 75%), and with discharge from hospital 60,2+1,67% (from 55 to 75%). In patients ІІ-st group EF LV special no change and made up to operation 65,82+4,33% (from 59 to 75%), and at leave the hospital 67,82+2,9% (from 65 to 85%). The period to stay of patients І-st group in hospital made up 7,7+1,0, ІІ-st group – 15,9+1,9 days (Р<0,01). Such different due to smaller traumatic this chirurgical procedure in І-st group. After surgical correction noted good direct and mi-distance results regarding gradient on ajrtic valvule and degrees failure. Conclusions. Both surgical valvuloplasty and balloon valvuloplasty are of effective methods treatment aortic stenosis in infants with good direct results. These data suggest that balloon valvuloplasty can be acceptable alternative to surgical treatment in patients with expressed cardiac failure. But it has tendency to increases aortic failure in remote period. The term stay treanmetn with ballon valvuloplasty twice short of period’s held with surgical aortic valvuloplasty. This substantially increased economical expenses on treanment.
сritical aortic stenosis, surgical aortic valvuloplasty, ballon valvuloplasty, infants.
Publication of the article:
«Bulletin of problems biology and medicine» Issue 3 (152), 2019 year, 113-117 pages, index UDK 616.132-007.271-053.31-089.844