Tayama M, Hirata N, Matsushita T, Sano T, Fukushima N, Sawa Y, Nishimura T, Matsuda H
First Department of Surgery, Osaka University Medical School, Japan.
Heart Vessels. 1999;14(3):154-60. doi: 10.1007/BF02482300.
In total cavopulmonary connection (TCPC), the anastomotic portion of the caval veins to the pulmonary artery (PA) is decided empirically based on personal experience. To compare the pulmonary flow distribution from both caval veins in various types of cavopulmonary anastomosis, intrapulmonary ventilation-perfusion distribution after TCPC was studied using lung scanning. We studied 11 patients, 2 to 37 years old, at 30-84 months after TCPC. Lung scanning was performed by administering 185 MBq of xenon-133 saline solution from their upper extremities and, after xenon-133 was washed out, from their lower extremities. Radionuclide counts on both lungs were obtained and intrapulmonary ventilation-perfusion distribution was assessed. In 4 patients whose superior vena cava (SVC)-PA anastomosis was on the right side of the inferior vena cava (IVC)-PA anastomosis, the blood flow distribution of the right and left lungs was 57.4%: 42.6%. In 3 patients whose SVC-PA anastomosis was on the left side of the IVC-PA anastomosis, the blood flow distribution of the right and left lungs was equal in both lungs (right, 53.1%; left, 46.9%). Systemic arterial oxygen saturation increased after TCPC (before TCPC, 85.3% +/- 2.7% and after TCPC, 89.8% +/- 2.3% (P < 0.05) in group R; before TCPC, 86.1% +/- 2.8% and after TCPC, 93.6% +/- 0.6% (P < 0.02) in group L). After TCPC, the value in group L had a tendency to be greater than that in group R (P < 0.04), in spite of the same values of systemic arterial oxygen saturation before TCPC and cardiac index (group R, 2.9 +/- 0.96; group L, 3.4 +/- 0.37). Lung scanning with xenon-133 revealed the distribution of pulmonary blood flow in the patients after TCPC quantitatively, and in the patients whose SVC-PA anastomosis was on the left side of the IVC-PA anastomosis, the right and left balance of the pulmonary blood flow distribution appeared to be more balanced compared with patients whose connection was done the opposite way.
在全腔静脉-肺动脉连接术（TCPC）中，腔静脉与肺动脉（PA）的吻合部分是根据个人经验凭经验确定的。为了比较不同类型腔肺吻合术中两条腔静脉的肺血流分布情况，我们采用肺部扫描研究了TCPC术后肺内通气-灌注分布。我们研究了11例年龄在2至37岁之间、TCPC术后30至84个月的患者。通过从患者上肢注入185MBq的氙-133盐水溶液进行肺部扫描，在氙-133排出后，再从下肢注入。获取双肺的放射性核素计数并评估肺内通气-灌注分布。在4例上腔静脉（SVC）-PA吻合位于下腔静脉（IVC）-PA吻合右侧的患者中，右肺和左肺的血流分布为57.4%:42.6%。在3例SVC-PA吻合位于IVC-PA吻合左侧的患者中，双肺的右肺和左肺血流分布相等（右肺，53.1%；左肺，46.9%）。TCPC术后全身动脉血氧饱和度升高（R组：TCPC术前为85.3%±2.7%，术后为89.8%±2.3%（P<0.05）；L组：TCPC术前为86.1%±2.8%，术后为93.6%±0.6%（P<0.02））。尽管TCPC术前全身动脉血氧饱和度和心指数值相同（R组，2.9±0.96；L组，3.4±0.37），但TCPC术后L组的值有高于R组的趋势（P<0.04）。用氙-133进行肺部扫描定量显示了TCPC术后患者的肺血流分布，与吻合方式相反的患者相比，SVC-PA吻合位于IVC-PA吻合左侧的患者肺血流分布的左右平衡似乎更好。
