Odim J N, Laks H, Drinkwater D C, George B L, Yun J, Salem M, Allada V
Division of Cardiothoracic Surgery, University of California, Los Angeles Medical Center, 90095, USA.
Ann Thorac Surg. 1999 Sep;68(3):962-7; discussion 968. doi: 10.1016/s0003-4975(99)00792-4.
The surgical management of neonatal systemic outflow obstruction and complex single ventricle pathology is variable.
In 15 neonates (12 boys and 3 girls) with complex forms of single-ventricle pathology and aortic coarctation or interruption, an initial strategy of banding the pulmonary artery and repair of the obstruction from a left thoracotomy was undertaken.
The median age at operation was 6 days (range 2 to 33 days) and the median weight was 3.3 kg (range 2 to 4.6 kg). There were no early deaths and one late death after the initial surgical palliation. Of the 14 survivors, 8 have undergone a bidirectional cavopulmonary anastomosis. The median age for bidirectional Glenn was 9.75 months (range 3.5 to 26 months). Seven infants have required Damus-Kaye-Stansel reconstruction for subaortic obstruction (one early death). The median age of the Damus-Kaye-Stansel procedure was 4 months (range 3 weeks to 9 months). Thirteen of 15 patients (87%) are alive and 6 have proceeded to a Fontan operation (median follow-up 68 months). A single failing Fontan required takedown to bidirectional Glenn and central shunt.
Our experience suggests that this high-risk subgroup of neonates with aortic obstruction and single-ventricle pathophysiology is safely managed by initial pulmonary artery banding palliation and repair of aortic obstruction. This strategy, careful surveillance, and early relief of subaortic stenosis can maintain acceptable anatomy and hemodynamics for later bidirectional Glenn and Fontan procedures.
新生儿系统性流出道梗阻及复杂单心室病变的手术治疗方法各异。
对15例患有复杂形式单心室病变合并主动脉缩窄或中断的新生儿（12例男童和3例女童），采用经左胸切口先行肺动脉环缩并修复梗阻的初始策略。
手术时的中位年龄为6天（范围2至33天），中位体重为3.3千克（范围2至4.6千克）。初始手术姑息治疗后无早期死亡病例，有1例晚期死亡。在14名存活者中，8例已接受双向腔肺吻合术。双向格林手术的中位年龄为9.75个月（范围3.5至26个月）。7例婴儿因主动脉下梗阻需要进行达穆斯-凯-斯坦塞尔重建术（1例早期死亡）。达穆斯-凯-斯坦塞尔手术的中位年龄为4个月（范围3周至9个月）。15例患者中有13例（87%）存活，6例已进行了Fontan手术（中位随访68个月）。1例功能衰竭的Fontan手术需要改为双向格林手术并建立中心分流。
我们的经验表明，对于患有主动脉梗阻和单心室病理生理的这一高危新生儿亚组，通过初始肺动脉环缩姑息治疗和主动脉梗阻修复可进行安全管理。这一策略、仔细的监测以及早期解除主动脉下狭窄能够为后续的双向格林手术和Fontan手术维持可接受的解剖结构和血流动力学。
