Mahle William T, Cuadrado Angel R, Tam Vincent K H
Sibley Heart Center, Children's Healthcare of Atlanta, and Division of Cardiology, Emory University School of Medicine, Georgia 30322, USA.
Ann Thorac Surg. 2003 Oct;76(4):1084-8; discussion 1089. doi: 10.1016/s0003-4975(03)00343-6.
A recent modification to the Norwood procedure involves the use of a right-ventricle (RV) to pulmonary artery (PA) conduit to provide pulmonary blood flow for patients with hypoplastic left heart syndrome (HLHS). This modification is thought to provide more stable hemodynamics by avoiding the diastolic "run-off" that occurs with a Blalock-Taussig shunt.
We reviewed our experience with the first 11 patients undergoing the RV-PA conduit modification of the Norwood operation and compared their outcomes with those of the preceding 22 patients who underwent a conventional Norwood procedure.
Between July 1999 and March 2002, 33 patients with HLHS underwent the Norwood procedure at a median age of 5 days (range 1 to 31 days). Aortic atresia was present in 28 (85%). No significant difference was noted between the RV-PA (n = 11) and conventional Norwood (n = 22) groups with respect to measures of morbidity such as duration of mechanical ventilation or hospital stay. Patients who underwent the conventional Norwood procedure did have significantly lower diastolic blood pressure in the early postoperative period (38.4 +/- 4.4 mm Hg versus 49.5 +/- 4.3 mm Hg, p = 0.001). The operative and 1-year survival rates were 81% and 81%, respectively, for patients with the RV-PA modification, which was not significantly different from those of patients who underwent the conventional procedure, 81% and 73% (p = 1.00 and p = 0.36). Two patients developed a pseudoaneurysm of the RV infundibulum after placement of RV-PA conduit. Four sudden deaths occurred after hospital discharge, all occurring in the conventional Norwood group.
The RV-PA conduit modification of the Norwood procedure results in excellent early survival. By avoiding low diastolic blood pressure this modification may provide superior perfusion to the coronary vascular bed and potentially reduce the risk of sudden unexpected death.
诺伍德手术最近的一项改进是使用右心室（RV）至肺动脉（PA）导管，为左心发育不全综合征（HLHS）患者提供肺血流。这种改进被认为通过避免布莱洛克 - 陶西格分流术出现的舒张期“血流流失”，从而提供更稳定的血流动力学。
我们回顾了首批11例行诺伍德手术右心室 - 肺动脉导管改良术患者的经验，并将其结果与之前22例行传统诺伍德手术患者的结果进行比较。
1999年7月至2002年3月期间，33例HLHS患者接受了诺伍德手术，中位年龄为5天（范围1至31天）。28例（85%）存在主动脉闭锁。在机械通气时间或住院时间等发病率指标方面，右心室 - 肺动脉导管组（n = 11）和传统诺伍德组（n = 22）之间未发现显著差异。接受传统诺伍德手术的患者在术后早期舒张压显著较低（38.4±4.4 mmHg对49.5±4.3 mmHg，p = 0.001）。右心室 - 肺动脉导管改良术患者的手术生存率和1年生存率分别为81%和81%，与接受传统手术患者的81%和73%相比，无显著差异（p = 1.00和p = 0.36）。2例患者在放置右心室 - 肺动脉导管后发生右心室漏斗部假性动脉瘤。4例患者出院后突然死亡，均发生在传统诺伍德组。
诺伍德手术的右心室 - 肺动脉导管改良术可实现出色的早期生存率。通过避免低舒张压，这种改良可能为冠状动脉血管床提供更好的灌注，并有可能降低突然意外死亡的风险。
