Chu Junmin, Wu Qingyu, Wang Wenming
Cardiovascular Institute and Fuwai Hospital, CAMS & PUMC, Beijing 100037.
Chin Med Sci J. 2003 Mar;18(1):46-9.
To assess the feature of pulmonary blood flow distribution after total cavopulmonary connection (TCPC) of different types, and to provide the selection of the best type.
Thirty-two consecutive survival patients after TCPC underwent radionuclide lung perfusion imaging. According to the radionuclide counts in the left and right lungs, analyses of the distribution of blood flow from superior venous cava (SVC) and inferior venous cava (IVC) and the whole pulmonary blood flow in both lungs were made. All patients were divided into 4 groups by the the anastomosis between IVC and pulmonary artery.
Group I: The flow ratio of the IVC to left lung was greater than that to the right lung, P < or = 0.01; the flow ratio of the SVC to right lung was greater than that to the left lung, P < or = 0.01; and the whole pulmonary blood flow went dominantly to the left lung, P < or = 0.05, which is not in line with physiological distribution. Group II: the flows from the SVC and IVC were mixed in the middle of the junction and ran evenly into the right and left lungs, the whole pulmonay blood flow went to both lungs, P > or = 0.05. Group III: the flow ratio of the SVC to both lungs were the same, P > or = 0.05, and major part from IVC went to the right lung, P < or = 0.01; the pulmonary blood flow go dominantly to the right lung, P < or = 0.05, which is in accord with physiological distribution. Group IV: the flows from the right SVC went to right lung by 100%, P < or = 0.01, and that from the left SVC went to left lung by 100% too, P < or = 0.01; the flows from IVC went dominantly to the left lung, with little part to the right lung, P < or = 0.05.
Different types of TCPC can result in different pulmonary blood distributions. The best flow distribution between the left and right lungs can be obtained by an offset of the IVC anastomosis toward the RPA with widening anastomosis for the patients without persist left superior venous cava (PLSVC).
评估不同类型全腔静脉肺动脉连接术（TCPC）后肺血流分布特点，为最佳术式选择提供依据。
32例TCPC术后存活患者接受放射性核素肺灌注显像。根据左右肺放射性核素计数，分析上腔静脉（SVC）和下腔静脉（IVC）血流分布及双肺整体肺血流情况。所有患者根据IVC与肺动脉吻合方式分为4组。
Ⅰ组：IVC至左肺血流比大于至右肺，P≤0.01；SVC至右肺血流比大于至左肺，P≤0.01；双肺整体肺血流主要流向左肺，P≤0.05，不符合生理分布。Ⅱ组：SVC和IVC血流在吻合处中部混合，均匀流入左右肺，双肺整体肺血流分布于双肺，P≥0.05。Ⅲ组：SVC至双肺血流比相同，P≥0.05，IVC大部分血流流向右肺，P≤0.01；肺血流主要流向右肺，P≤0.05，符合生理分布。Ⅳ组：右SVC血流100%流向右肺，P≤0.01，左SVC血流100%流向左肺，P≤0.01；IVC血流主要流向左肺，少量流向右肺，P≤0.05。
不同类型的TCPC可导致不同的肺血流分布。对于无永存左上腔静脉（PLSVC）的患者，通过将IVC吻合口向右侧肺动脉偏移并扩大吻合口，可获得左右肺之间最佳的血流分布。
