Giannico S, Corno A, Marino B, Cicini M P, Gagliardi M G, Amodeo A, Picardo S, Marcelletti C
Department of Pediatric Cardiology and Cardiac Surgery, Ospedale Bambino Gesù, Rome, Italy.
Circulation. 1992 Nov;86(5 Suppl):II110-7.
Total cavopulmonary connection has been proposed as a rational alternative to atriopulmonary connection for complex Fontan operations. In addition to fluid dynamic advantages proposed by de Leval, total right heart bypass may address an emerging important issue after repair of single ventricle: late atrial arrhythmias. The purpose of this study is to document the postoperative hemodynamic findings in 22 consecutive patients who received a total extracardiac right heart bypass with an inferior vena cava-to-pulmonary artery extracardiac Dacron conduit with a modified Glenn anastomosis (superior vena cava-to-pulmonary artery anastomosis).
Twenty-eight patients with complex congenital heart disease underwent this surgical procedure. One patient died (early mortality, 3.5%). Mean follow-up was 13.9 months. Postoperative cardiac catheterization and echo Doppler studies were performed in 22 of the 27 survivors. In 18 of 22 patients, hemodynamic data were satisfactory; a preferential direction of caval flows to both lungs was observed. Echo Doppler assessments show that forward cavopulmonary flow appears as a predominant early diastolic event, in contrast to what occurs in atriopulmonary connections. This hemodynamic model emphasizes the possible role of the diastolic ventricular performance (as a "suction pump") in Fontan circulation. Early postoperative atrial arrhythmias were observed in two of the survivors.
The technical advantages and the hemodynamic benefits of this form of right heart bypass are encouraging. Although the use of artificial material in this procedure is extensive, none of the survivors showed thromboembolic complications or peel formations with narrowing and/or obstruction. Further investigations during a longer follow-up are needed to confirm the early and intermediate results, especially the reduction of late atrial arrhythmias.
对于复杂的Fontan手术，全腔肺连接已被提议作为心房肺连接的合理替代方案。除了德·莱瓦尔提出的流体动力学优势外，全右心旁路可能解决单心室修复后一个新出现的重要问题：晚期房性心律失常。本研究的目的是记录22例连续接受全体外循环右心旁路手术患者的术后血流动力学结果，该手术采用下腔静脉至肺动脉的体外涤纶管道及改良的格林吻合术（上腔静脉至肺动脉吻合术）。
28例复杂先天性心脏病患者接受了该手术。1例患者死亡（早期死亡率为3.5%）。平均随访时间为13.9个月。27例幸存者中的22例进行了术后心导管检查和超声多普勒研究。22例患者中有18例血流动力学数据令人满意；观察到腔静脉血流优先流向双肺。超声多普勒评估显示，与心房肺连接的情况相反，正向腔肺血流表现为舒张早期的主要事件。这种血流动力学模型强调了舒张期心室功能（作为“抽吸泵”）在Fontan循环中的可能作用。两名幸存者术后早期出现房性心律失常。
这种形式的右心旁路的技术优势和血流动力学益处令人鼓舞。尽管该手术中人工材料的使用广泛，但所有幸存者均未出现血栓栓塞并发症或伴有狭窄和/或阻塞的剥离形成。需要更长时间的随访进行进一步研究，以证实早期和中期结果，特别是晚期房性心律失常的减少。
