Alexi-Meskishvili V, Ovroutski S, Ewert P, Dähnert I, Berger F, Lange P E, Hetzer R
Department of Cardiovascular and Thoracic Surgery, German Heart Institute (Deutsches Herzzentrum Berlin), Berlin, Germany.
Eur J Cardiothorac Surg. 2000 Dec;18(6):690-5. doi: 10.1016/s1010-7940(00)00593-5.
Lack of conduit growth potential and thrombogenicity are the main drawbacks of the extracardiac Fontan operation (ECFO). Optimal size of the conduit according to the patients age and inferior vena cava diameter has not been established.
We set out to ascertain whether the optimal dimensions of the conduit could be determined before an ECFO.
Actual and expected age-related inferior vena cava diameters were compared with the extracardiac conduit diameter in 20 patients after ECFO. In 50 other pediatric and adult patients, the distance between intrapericardial part of the inferior vena cava and the undersurface of the right pulmonary artery (IVC-RPA) was measured. Cases of conduit thrombosis were analyzed.
The actual diameter of the inferior vena cava was variable and has a weak correlation with anthropometric data and expected diameter (R=0.07-0.23, P=0.32-0.76). The IVC-RPA distance correlated with height (R=0.87, P=0.0001), but was also variable. At the age of 2-4 years and body weight 12-15 kg IVC diameter and IVC-RPA distance are equal to 60-80% of adult values. Conduit thrombosis developed in two patients with unfavorable Fontan hemodynamics and oversized conduits.
Considering the inferior vena cava size, ECFO may be performed at the age of 2-3 years and at a body weight 12-15 kg, when a hemodynamically optimal almost adult sized conduit can be implanted. Optimization of the conduit is necessary on the basis of the actual inferior vena cava diameter and IVC-RPA distance. Anticoagulation postoperatively should be considered to prevent conduit thrombosis in patients with suboptimal Fontan circulation
心外Fontan手术（ECFO）的主要缺点是管道生长潜力不足和血栓形成倾向。尚未确定根据患者年龄和下腔静脉直径的最佳管道尺寸。
我们试图确定在ECFO之前是否可以确定管道的最佳尺寸。
将20例ECFO术后患者的实际和预期年龄相关的下腔静脉直径与心外管道直径进行比较。在另外50例儿科和成人患者中，测量下腔静脉心包内部分与右肺动脉下表面之间的距离（IVC-RPA）。分析管道血栓形成的病例。
下腔静脉的实际直径是可变的，与人体测量数据和预期直径的相关性较弱（R = 0.07 - 0.23，P = 0.32 - 0.76）。IVC-RPA距离与身高相关（R = 0.87，P = 0.0001），但也是可变的。在2 - 4岁且体重12 - 15 kg时，IVC直径和IVC-RPA距离等于成人值的60 - 80％。两名Fontan血流动力学不良且管道过大的患者发生了管道血栓形成。
考虑到下腔静脉大小，ECFO可在2 - 3岁且体重12 - 15 kg时进行，此时可以植入血流动力学最佳的几乎成人尺寸的管道。根据实际下腔静脉直径和IVC-RPA距离对管道进行优化是必要的。对于Fontan循环欠佳的患者，术后应考虑抗凝以预防管道血栓形成。
