Pizarro Christian, Malec Edward, Maher Kevin O, Januszewska Katarzyna, Gidding Samuel S, Murdison Kenneth A, Baffa Jeanne M, Norwood William I
Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Circulation. 2003 Sep 9;108 Suppl 1:II155-60. doi: 10.1161/01.cir.0000087390.94142.1d.
Diastolic run off into the pulmonary circulation and labile coronary perfusion are thought to contribute to morbidity and mortality after the Norwood procedure (NP). We compared outcomes from the use of a RV to PA conduit (RV/PA) or a modified Blalock-Taussig shunt (BTS), physiologically distinct sources of pulmonary blood flow.
Review of 56 consecutive patients who underwent a Norwood procedure with a RV/PA (n=36) or a BTS (n=20) between 2000 and 2002. Median age was 4.5 days (range 1 to 40) and median weight was 3.1 kg (range 1.8 to 4.1). The RV/PA was constructed with a 5-mm conduit. Patients in the BTS group received a 4-mm shunt. Comparisons between RV/PA and BTS groups showed no difference for weight, gestational age, prenatal diagnosis, HLHS variant, associated diagnoses, ascending aortic size, ventricular function, AV valve function, and pulmonary venous obstruction. Operative survival was higher with RV/PA [33/36 (92%) versus 14/20 (70%); P=0.05]. Patients with RV/PA had less need for ventilatory manipulations to balance the Qp/Qs (1/36 v/s 8/20; P=0.001), delayed sternal closure (6/36 v/s 7/20; P=0.001), and extracorporeal support (5/36 v/s 7/20; P=0.036). RV/PA patients had more favorable postoperative hemodynamics: higher diastolic blood pressure without changes in systolic blood pressure at 1, 8, 24, 48 hours after the NP (46.3 v/s 39.5; 47.2 v/s 42.1; 46.1 v/s 37.1; and 47.1 v/s 40.2; all P=0.001).
RV/PA simplifies postoperative management and improves hospital survival after NP for HLHS.
舒张期血液流入肺循环以及不稳定的冠状动脉灌注被认为是导致诺伍德手术（NP）后发病和死亡的原因。我们比较了使用右心室至肺动脉导管（RV/PA）或改良布莱洛克-陶西格分流术（BTS）这两种生理上不同的肺血流来源后的结果。
回顾了2000年至2002年间连续接受诺伍德手术的56例患者，其中使用RV/PA的有36例，使用BTS的有20例。中位年龄为4.5天（范围1至40天），中位体重为3.1千克（范围1.8至4.1千克）。RV/PA采用5毫米导管构建。BTS组患者接受4毫米分流。RV/PA组和BTS组在体重、胎龄、产前诊断、左心发育不全综合征类型、相关诊断、升主动脉大小、心室功能、房室瓣功能和肺静脉梗阻方面无差异。RV/PA组的手术生存率更高[33/36（92%）对14/20（70%）；P=0.05]。使用RV/PA的患者为平衡肺循环血流量与体循环血流量（Qp/Qs）而进行通气操作的需求更少（1/36对8/20；P=0.001），延迟关胸的情况更少（6/36对7/20；P=0.001），体外支持的需求也更少（5/36对7/20；P=0.
